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Daily Dose: HDL-C and Fracture Risk in Older Adults

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.


On January 20, 2023, we reported on a study published in JAMA Cardiology that examined associations between high-density lipoprotein cholesterol (HDL-C) level and traumatic and minimal trauma fractures in healthy older adults.

The study

Researchers conducted a post-hoc analysis of data from adults participating in the ASPREE (Aspirin in Reducing Events in the Elderly) study and the ASPREE-Fracture substudy. ASPREE participants from Australia (n=16 703) were aged ≥70 years and those from the US (n=2411) aged ≥65 years and were recruited between March 2010 and December 2014. All were judged free of cardiovascular disease (CVD), dementia, physical disability, and chronic illness at baseline. The ASPREE-Fracture substudy collected data on fractures reported after randomization from Australian participants only.

In a model fully adjusted for potential confounding variables, each 1-SD increment in HDL-C level was associated with a 14% higher risk for fractures (HR 1.14, 95% CI 1.08-1.2). When investigators analyzed HDL-C in quintiles, compared with participants in Q1, participants in Q5 had a 33% higher risk of fracture (HR, 1.33; 95% CI, 1.14-1.54). The associations between HDL-C level and fractures were linear for both men and women.

In analyses stratified by sex and limited to only minimal trauma fractures and participants not taking osteoporosis medications, the results remained consistent. The researchers observed no association between non-HDL-C levels and fractures.

Clinical implications

“This cohort study provides robust evidence that higher levels of HDL-C are associated with incident fractures in both male and female individuals, independent of conventional risk factors...These findings highlight another potential concern with high HDL-C levels and another likely adverse effect of the drugs that substantially increases plasma HDL-C levels. Further research is needed to determine the pathophysiological explanation for these findings."

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