Association between lipid biomarkers and bone mineral density: a cross-sectional study from NHANES 2007–2010

Background: Bone mineral density (BMD) is an established indicator of bone health, with lower BMD associated with increased risk of osteoporosis and fractures. Triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) are acknowledged as novel lipid biomarkers. However, the relationship between lipid biomarkers and BMD remains uncertain. This study examines the association between lipid biomarkers and BMD in a representative US population. Methods: Utilizing cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2007–2010, we analyzed BMD measurements at the total femur, femoral neck, and lumbar spine. Serum lipid levels, including TG, TC, LDL and HDL, were assessed. Multivariable regression models adjusted for confounders such as age, gender, race, BMI, laboratory indices, and lifestyle factors were used to explore the association between lipid biomarkers and BMD. In addition, several subgroup analyses were conducted to assess the robustness of the outcomes. Results: Our cross-sectional analysis included a total of 3213 participants from the NHANES 2007–2010 dataset, representing a diverse adult population, identified significant associations between lipid biomarkers and bone mineral density (BMD) at key anatomical sites. This study found that TC and HDL were negatively correlated with femoral BMD, and TG was positively correlated with femoral BMD. After fully adjusting for covariates, the negative association between TC and lumbar BMD remained significant (β= -0.0002,95%CI: -0.0004 to -0.0001, p<0.001). After transforming TC into categorical variables (quartiles), participants in the highest quartile of TC showed significantly lower BMD measurements compared with those in the lowest quartile (β= -0.019,95%CI: -0.033 to -0.005, p=0.007). Subgroup analysis showed that the association between TC and lumbar BMD was more pronounced in women (β= -0.042,95%CI: -0.053 to -0.030, p<0.001) and Mexican Americans (β= -0.093,95%CI: -0.109 to -0.076, p<0.001). Gender and ethnic differences were prominent in the lipid-BMD association, highlighting the importance of considering demographic factors when assessing the risk of osteoporosis. Conclusions: HDL and TC were negatively correlated with total femoral BMD, and TG was positively correlated with femoral BMD. And TC might serve as a potential lipid biomarkers of osteoporosis outperforming HDL, TG and LDL. The complex correlation between the lipid biomarkers and bone metabolism requires further evaluation in large prospective studies. The observed gender and racial differences in these associations underscore the need for personalized approaches in osteoporosis risk assessment and management.