Effect of a combination of cumulative remnant cholesterol and systemic inflammation on the risk of fragility fracture: A prospective cohort study

Abstract

We aimed to evaluate the effect of a combination of the cumulative remnant cholesterol (cumRC) concentration and the cumulative monocyte/lymphocyte ratio (cumMLR) or the cumulative systemic inflammation response index (cumSIRI) on the risk of fragility fracture. We studied 38,900 participants who completed the Kailuan health examinations in 2006, 2008, and 2010. The baseline characteristics of six groups created according to the cumRC tertile and cumMLR median were compared. The incidence density was calculated, and the log-rank test was employed to compare the cumulative incidences. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95 % confidence intervals (CIs), and the restricted cubic spline method was used to evaluate the possibility of non-linear relationships of cumRC, cumMLR, or cumSIRI with the risk of fragility fracture. Additional analyses were performed after stratification according to body mass index (BMI ≥ or <24 kg/m²). During a median follow-up period of 12.00 years, a total of 581 fragility fractures occurred. Compared to the medium cumRC & low cumMLR group, the risk of fragility fracture was highest in the high cumRC & high cumMLR group (HR = 1.69, 95 % CI: 1.24–2.30), followed by the low cumRC & high cumMLR group (HR = 1.59, 95 % CI: 1.17–2.15). Compared to the medium cumRC & low cumSIRI, the risk of fragility fracture was highest in the low cumRC & high cumSIRI group (HR = 1.62, 95 % CI: 1.18–2.22), followed by the high cumRC & high cumSIRI group (HR = 1.59, 95 % CI: 1.16–2.19). Thus, the combination of either excessively low or high cumRC and high cumMLR or cumSIRI is associated with a higher risk of fragility fracture, and this association is particularly marked for individuals with BMI <24 kg/m².