TOPLINE:

Elevated levels of high-density lipoprotein (HDL) cholesterol were associated with an increased long-term risk for new-onset fractures in men, but not in women.

METHODOLOGY:

• Researchers conducted a prospective population-based cohort study to examine the relationship between levels of HDL cholesterol and new fractures.
• They analysed data of 18,240 Swedish individuals (mean age, 69 years; 37% women), which included HDL cholesterol levels and other relevant parameters.
• The primary outcome was total incident fractures, identified from national registers. Secondary outcomes included site-specific incident fractures.
• The mean follow-up duration was 12.6 years.

TAKEAWAY:

• Incident fractures occurred in 25.8% of individuals, of whom 54% were women.
• Individuals with incident fractures had higher mean HDL cholesterol levels than those without fractures (1.5 vs 1.4 mmol/L).
• Each 1-mmol/L increase in HDL cholesterol levels was associated with a 12% increased risk for total incident fractures in the general population (P = .006) and an 18% increased risk in men (P = .02). Such an association was not found in women.
• HDL cholesterol levels were not associated with the site-specific risk for incident fractures in the hip, femur, or lower leg.

IN PRACTICE:

"When advocating for cardiovascular benefits of higher HDL levels, clinicians must concurrently evaluate and address bone health, especially in active aging men," the authors wrote.

SOURCE:

This study was led by Richard Sutton, Lund University, Malmö, Sweden. It was published online on October 31, 2025, in Osteoporosis International.

LIMITATIONS:

This study was observational and did not imply that high HDL cholesterol levels caused new fractures. Vitamin D levels were not available for the analysis. Serum calcium and phosphate levels and bone mineral density were only measured at baseline.

DISCLOSURES:

This study did not receive any specific funding. One author reported receiving payment for lectures from Link and Swemac.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.