Triglyceride Levels and Fracture Risk in Midlife Women: Study of Women's Health Across the Nation (SWAN)

• Published in: The journal of clinical endocrinology and metabolism 2016-09, Vol.101 (9), p.3297-3305
• Main Authors: Chang, Po-Yin, Gold, Ellen B, Cauley, Jane A, Johnson, Wesley O, Karvonen-Gutierrez, Carrie, Jackson, Elizabeth A, Ruppert, Kristine M, Lee, Jennifer S
• Format: Article
• Language: English
• Subjects: Adult; Biomarkers - blood; Female; Follow-Up Studies; Humans; Hypertriglyceridemia - complications; Longitudinal Studies; Menopause; Middle Aged; Original; Osteoporotic Fractures - blood; Osteoporotic Fractures - etiology; Osteoporotic Fractures - pathology; Prognosis; Prospective Studies; Risk Factors; Triglycerides - blood; Women's Health
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2016-1366

Context: Unfavorable lipid levels contribute to cardiovascular disease and may also harm bone health. Objective: Our objective was to investigate relationships between fasting plasma lipid levels and incident fracture in midlife women undergoing the menopausal transition. Design and Setting: This was a 13-year prospective, longitudinal study of multiethnic women in five US communities, with near-annual assessments. Participants: At baseline, 2062 premenopausal or early perimenopausal women who had no history of fracture were included. Exposures: Fasting plasma total cholesterol, triglycerides (TG), low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol at baseline and follow-up visits 1 and 3–7. Main Outcome Measure(s): Incident nontraumatic fractures 1) 2 or more years after baseline, in relation to a single baseline level of lipids; and 2) 2–5 years later, in relation to time-varying lipid levels. Cox proportional hazards modelings estimated hazard ratios and 95% confidence interval (CI). Results: Among the lipids, TG levels changed the most, with median levels increased by 16% during follow-up. An increase of 50 mg/dl in baseline TG level was associated with a 1.1-fold increased hazards of fracture (adjusted hazard ratio, 1.11; 95% CI, 1.04–1.18). Women with baseline TG higher than 300 mg/dl had an adjusted 2.5-fold greater hazards for fractures (95% CI, 1.13–5.44) than women with baseline TG lower than 150 mg/dl. Time-varying analyses showed a comparable TG level-fracture risk relationship. Associations between total cholesterol, low-density lipoprotein cholesterol, or high-density lipoprotein cholesterol levels and fractures were not observed. Conclusions: Midlife women with high fasting plasma TG had an increased risk of incident nontraumatic fracture. Secondary Abstract: Midlife women with fasting plasma triglyceride (TG) of at least 300 mg/dl had 2.5-fold greater hazards of fracture in 2 years later and onward, compared to those with TG below 150 mg/dl, in a multiethnic cohort. Time-varying analyses revealed comparable results. Midlife women with fasting plasma TG ≥ 300 mg/dL had 2.5-fold greater hazards of fracture in 2 years later and onward, compared to those with TG ≤150 mg/dL, in a multi-ethnic cohort. Time-varying analyses revealed comparable results.