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

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Abstract

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.

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