中国骨质疏松杂志

脂质生物标志物与骨密度的相关性研究

Study of the correlation between lipid biomarkers and bone mineral density

DOI：10.3969/j.issn.1006-7108.2025.03.008

英文关键词:bone mineral density osteoporosis lipid biomarkers NHANES

基金项目:国家自然科学基金（82374482）；广州中医药大学第三附属医院科研创新基金课题（Sy2022006）

作者	单位
钟业霖1 刘志文1 田瀚3 张银银1 熊诗硕1 张宇楷1 黄宏兴2 郭海威2 李启活2 李颖2*	1.广州中医药大学第三临床医学院，广东广州 510405 2.广州中医药大学第三附属医院，广东广州 510378 3.广州市越秀区骨伤康复医院，广东广州 510199

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中文摘要:

目的探究脂质生物标志物与骨密度的相关性。方法利用2007—2010年NHANES数据库的横断面数据，通过筛选共纳入了3 213名参与者，获取其全股骨、股骨颈和腰椎的骨密度（bone mineral density，BMD），以及脂质生物标志物，包括三酰甘油（triglycerides，TG）、总胆固醇（total cholesterol，TC）、高密度脂蛋白(high-density lipoprotein，HDL)和低密度脂蛋白( low-density lipoprotein，LDL)等数据。采用多元线性回归模型和平滑曲线拟合，校正年龄、性别、种族、体质指数、实验室指标和生活方式等混杂因素，探讨脂质生物标志物与BMD之间的相关性。此外，通过进行亚组分析以评估结果的稳健性。结果经完全调整协变量后，TG、HDL与总股骨、股骨颈、腰椎BMD均无明显相关性（P>0.05）。TC与股骨颈、腰椎BMD呈负相关[股骨颈：β=?0.0001，95 %CI(?0.0002~?0.0000)，P=0.030；腰椎：β=?0.0002，95 %CI(?0.0004~?0.0001)，P<0.001]。LDL与总股骨BMD无明显相关性，而与股骨颈、腰椎BMD呈负相关[股骨颈：β=?0.0001，95 %CI(?0.0003~?0.0000)，P=0.019；腰椎：β=?0.0003，95 %CI(?0.0004~?0.0001)，P<0.001]。亚组分析结果显示，经完全调整协变量后，在女性[β =?0.0002，95 %CI(?0.0004~?0.0000)，P=0.017]和非西班牙白人[β =?0.0003，95 %CI(?0.0004~?0.0001)，P=0.006]中，TC与腰椎BMD之间的负相关更为显著；而LDL与腰椎BMD的负相关关系在男性[β =?0.0003，95 %CI(?0.0005~?0.0001)，P=0.012]和非西班牙白人[β =?0.0003，95 %CI(?0.0005~?0.0001)，P=0.005]更为显著。采用平滑曲线拟合解决TC、LDL与腰椎BMD之间的非线性关系，结果显示TC、LDL与腰椎骨密度均呈线性负相关。在女性分组中，平滑曲线拟合结果提示TC与腰椎骨密度之间为非线性关系，存在1个拐点，使用二分段线性回归模型分析显示拐点是180 mg/dL。结论 TC、LDL与股骨颈、腰椎BMD均呈负相关关系。相较于TG、HDL，TC、LDL可能是识别骨质疏松症的潜在脂质生物标志物。

英文摘要:

Objective To explore the correlation between lipid biomarkers and bone mineral density. Methods Using cross-sectional data from the NHANES database from 2007-2010, a total of 3,213 participants were included by screening to obtain their bone mineral density (BMD) of the total femur, femoral neck, and lumbar spine, as well as lipid biomarkers, including triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL), and other data. Multiple linear regression models and smoothed curve fitting were used to correct for confounders such as age, sex, race, body mass index, laboratory parameters, and lifestyle to explore the correlation between lipid biomarkers and BMD. In addition, subgroup analyses were performed to assess the robustness of the results. Results After fully adjusting for covariates, TG and HDL were not significantly correlated with BMD of the total femur, femoral neck, and lumbar spine (P>0.05). TC was negatively correlated with BMD of the femoral neck and lumbar spine [femoral neck: β=?0.0001, 95%CI (?0.0002,?0.0000), P=0.030; lumbar spine: β=?0.0002, 95%CI (?0.0004,?0.0001), P<0.001]. LDL was not significantly correlated with total femoral BMD, while it was negatively correlated with BMD of the femoral neck and lumbar spine [femoral neck: β=?0.0001, 95%CI (?0.0003,?0.0000), P=0.019; lumbar spine: β=?0.0003, 95%CI (?0.0004,?0.0001), P<0.001]. Subgroup analyses showed that after fully adjusting for covariates, the negative association between TC and lumbar spine BMD in women [β =?0.0002, 95%CI (?0.0004,?0.0000), P=0.017] and non-Hispanic whites [β =?0.0003, 95%CI (?0.0004,?0.0001), P=0.006] was more significant. The negative correlation between LDL and lumbar BMD was more significant in men [β =?0.0003, 95%CI (?0.0005,?0.0001), P=0.012] and non-Hispanic whites [β =?0.0003, 95%CI (?0.0005,?0.0001), P=0.005]. Smooth curve fitting was used to address the non-linear relationship among TC, LDL and lumbar BMD. The results showed that TC, LDL, and lumbar BMD were all linearly negatively correlated. In the female subgroup, the smoothed curve fitting results suggested a nonlinear relationship between TC and lumbar spine BMD, with one inflection point. Analysis using the piecewise linear regression model showed the inflection point to be 180 mg/dL. Conclusion TC and LDL are negatively correlated with BMD of the femoral neck and lumbar spine. Compared with TG and HDL, TC and LDL may be potential lipid biomarkers for the identification of osteoporosis.

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