The association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and bone mineral density in US adults: NHANES (2011-2018)

Background The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) represents a novel lipid marker. This study investigated the association between NHHR and lumbar bone mineral density (BMD) in the general American population. Methods Data from the National Health and Nutrition Examination Survey (NHANES) spanning 2011 to 2018 were used in this study, including 10,879 participants aged 20–59 years. To investigate the relationship between NHHR and lumbar BMD, we employed multivariate linear regression models along with stratified analyses. Additionally, we applied fitted smoothing curves and threshold effect analyses to explore the nonlinear association between NHHR and lumbar BMD. Results After adjusting for covariates, weighted multivariable linear regression models indicated a significant negative association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and lumbar bone mineral density (BMD) (β = -0.006, 95% CI: -0.008 to -0.003, P  < 0.001). Stratified subgroup analyses based on age, gender, race, BMI, hypertension, and diabetes consistently demonstrated this inverse relationship in males (β = -0.005, 95% CI: -0.008 to -0.002, P  = 0.002) and females (β = -0.007, 95% CI: -0.011 to -0.003, P  < 0.001); non-Hispanic whites (β = -0.005, 95% CI: -0.009 to -0.001, P  = 0.015), non-Hispanic blacks (β = -0.010, 95% CI: -0.017 to -0.004, P  = 0.003), and other races (β = -0.007, 95% CI: -0.011 to -0.003, P  = 0.001); participants aged 20–29 years (β = -0.006, 95% CI: -0.011 to -0.001, P  = 0.022) and 40–49 years (β = -0.008, 95% CI: -0.013 to -0.003, P  < 0.001); individuals with a BMI < 25 (β = -0.008, 95% CI: -0.014 to -0.002, P  = 0.010) and those with a BMI between 25 and 30 (β = -0.011, 95% CI: -0.015 to -0.007, P  < 0.001). For the total cohort, individuals of other races, and participants aged 30–39 years, a nonlinear relationship was examined with inflection points identified at NHHR values of 4.29, 5.26, and 2.91, respectively. Conclusions For US adults aged 20 to 59, our research identified an inverse relationship between the NHHR and lumbar BMD. This association was observed across the general cohort, individuals of other races, and participants aged 30–39 years, demonstrating a nonlinear relationship with inflection points at 4.29, 5.26, and 2.91, respectively. Consequently, NHHR could serve as a sensitive biomarker for the prevention of osteoporosis or osteopenia.