Association Between the Lymphocyte-to-High-Density Lipoprotein Cholesterol Ratio and Bone Mineral Density: A Cross-Sectional Study Based on NHANES 2011-2018.

Abstract

Objective: This study aimed to investigate the potential association between the lymphocyte-to-high-density lipoprotein cholesterol ratio (LHR) and bone mineral density (BMD).

Methods: This cross-sectional analysis utilized data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018, including 7,265 participants aged ≥20 years. Weighted multivariable linear regression models were employed to evaluate the associations between LHR and BMD at three skeletal sites: lumbar spine, trunk, and total body. Smooth curve fitting and threshold effect analysis were performed to explore non-linear relationships. Subgroup analyses were conducted according to age, sex, smoking status, alcohol consumption, and physical activity. To assess the robustness of the findings, sensitivity analyses were performed by excluding postmenopausal and hormone-treated women.

Results: In fully adjusted models, LHR was negatively associated with lumbar BMD (β = -0.007, 95% CI: -0.011 to -0.003), trunk BMD (β = -0.003, 95% CI: -0.006 to -0.001), and total BMD (β = -0.004, 95% CI: -0.007 to -0.002). All BMD indices exhibited significant nonlinear relationships (p for nonlinearity < 0.05). Subgroup analyses revealed that the inverse association between LHR and BMD was more pronounced among physically active participants (ap for interaction < 0.05), whereas no significant interactions were observed for other variables. Sensitivity analyses produced consistent results, supporting the robustness of the findings.

Conclusion: LHR was inversely and nonlinearly associated with BMD, suggesting its potential value as a novel biomarker for bone health assessment. Further prospective studies are warranted to validate its predictive utility and elucidate the underlying mechanisms.