{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:00:10Z","timestamp":1792598410928,"version":"4.5.0"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2023,3,1]]},"abstract":"<jats:sec id=\"ab-hbr220011-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Increased levels of high-density lipoprotein cholesterol (HDL-C) have been associated with osteoporosis. Preclinical studies have reported that HDL-C reduces bone mineral density by reducing osteoblast number and function. However, the clinical significance of these findings is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr220011-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether higher HDL-C levels are predictive of an increased fracture risk in healthy older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr220011-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This cohort study is a post hoc analysis of data from the Aspirin in Reducing Events in the Elderly (ASPREE) clinical trial and the ASPREE-Fracture substudy. ASPREE was a double-blind, randomized, placebo-controlled primary prevention trial of aspirin that recruited participants between 2010 and 2014. These comprised community-based older adults (16\u202f703 Australians aged \u226570 years, 2411 US participants \u226565 years) without evident cardiovascular disease, dementia, physical disability, and life-limiting chronic illness. The ASPREE-Fracture substudy collected data on fractures reported postrandomization from Australian participants. Cox regression was used to calculate hazard ratio (HR) and 95% CI. Data analysis for this study was performed from April to August 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr220011-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>Plasma HDL-C.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr220011-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Fractures included were confirmed by medical imaging and included both traumatic and minimal trauma fractures. Fractures were adjudicated by an expert review panel.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr220011-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 16\u202f262 participants who had a plasma HDL-C measurement at baseline (8945 female participants [55%] and 7319 male [45%]), 1659 experienced at least 1 fracture over a median (IQR) of 4.0 years (0.02-7.0 years). In a fully adjusted model, each 1-SD increment in HDL-C level was associated with a 14% higher risk of fractures (HR, 1.14; 95% CI, 1.08-1.20). The results remained similar when these analyses were stratified by sex. Sensitivity and stratified analyses demonstrated that these associations persisted when the analyses were repeated to include only (1) minimal trauma fractures, (2) participants not taking osteoporosis medications, (3) participants who were never smokers and reported that they did not drink alcohol, and (4) participants who walked outside for less than 30 minutes per day and reported no participation in moderate\/vigorous physical activity and to examine only (5) statin use. No association was observed between non\u2013HDL-C levels and fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr220011-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>This study suggests that higher levels of HDL-C are associated with an increased fracture risk. This association was independent of common risk factors for fractures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamacardio.2022.5124","type":"journal-article","created":{"date-parts":[[2023,1,18]],"date-time":"2023-01-18T11:02:27Z","timestamp":1674039747000},"page":"268","source":"Crossref","is-referenced-by-count":67,"title":["Association of Plasma High-Density Lipoprotein Cholesterol Level With Risk of Fractures in Healthy Older Adults"],"prefix":"10.1001","volume":"8","author":[{"given":"Sultana Monira","family":"Hussain","sequence":"first","affiliation":[{"name":"School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"},{"name":"Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter R.","family":"Ebeling","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna L.","family":"Barker","sequence":"additional","affiliation":[{"name":"School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"},{"name":"Silverchain, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence J.","family":"Beilin","sequence":"additional","affiliation":[{"name":"Medical School, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Tonkin","sequence":"additional","affiliation":[{"name":"School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J.","family":"McNeil","sequence":"additional","affiliation":[{"name":"School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"hbr220011r1","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1186\/s12891-020-3161-4","article-title":"Establishing baseline absolute risk of subsequent fracture among adults presenting to hospital with a minimal-trauma-fracture.","volume":"21","author":"Frost","year":"2020","journal-title":"BMC Musculoskelet Disord"},{"issue":"3","key":"hbr220011r2","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1007\/s00774-020-01189-9","article-title":"Blood lipid levels in patients with osteopenia and osteoporosis: a systematic review and meta-analysis.","volume":"39","author":"Zhao","year":"2021","journal-title":"J Bone Miner 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