| Objective To explore the relationship between the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) and the risk of lumbar osteopenia. Methods Based on data from the National Health and Nutrition Examination Survey (NHANES) for the years 2011-2018, this research included 8176 participants. Bone mineral density (BMD) in the lumbar spine was measured using dual-energy X-ray absorptiometry (DXA), and T-scores were calculated to determine the status of bone mass reduction. NHHR was computed by subtracting high-density lipoprotein cholesterol (HDL-C) from total cholesterol and dividing the result by HDL-C. Participants were divided into quartiles according to their NHHR levels, demographic characteristics, lifestyle factors (such as alcohol consumption, smoking, physical activity), and clinical variables (including BMI, hypertension, diabetes, etc.) were collected. The association between NHHR and lumbar osteopenia was assessed through multivariate linear regression analysis. Restricted cubic splines were used to investigate the relationship between NHHR and both lumbar osteopenia and lumbar spine BMD. Results The study found that the NHHR in the group with lumbar osteopenia was significantly higher than in the group without lumbar osteopenia (P<0.001). In unadjusted models, an increase in NHHR was positively associated with lumbar osteopenia (OR: 1.11, 95% CI:1.07-1.16, P<0.001). After adjusting for confounders such as age, sex, and BMI, the correlation weakened but remained significant (OR: 1.08, 95% CI:1.03-1.13, P=0.004). After comprehensive adjustment for lumbar spine BMD and lipid levels, the association between NHHR and lumbar osteopenia was no longer significant (OR: 0.99, P=0.931). Moreover, restricted cubic splines indicated a nonlinear relationship between NHHR and lumbar osteopenia, with a J-shaped curve suggesting that an increase in NHHR significantly elevated the risk of lumbar osteopenia (P<0.05). NHHR was negatively correlated with lumbar spine BMD, with fitting models showing that each unit increase in NHHR corresponds to a decrease of 0.01 g/cm2 in lumbar spine BMD. Conclusion NHHR may serve as a potential indicator for predicting the risk of lumbar osteopenia, although its association with lumbar osteopenia weakens after comprehensive adjustments, indicating the need for further research to clarify its mechanisms and clinical application value. |