{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T12:41:48Z","timestamp":1781440908805,"version":"3.54.1"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The intricate relationship between bone turnover biomarkers (BTMs) and lipid profiles, particularly high-density lipoprotein (HDL), remains partially understood. This study aims to clarify how HDL is associated with BTMs, which are key indicators of bone resorption and formation, in patients hospitalized with osteoporotic fractures (OPFs). Understanding this relationship could offer new insights for osteoporosis treatment and influence future therapeutic strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Conducted at the Affiliated Kunshan Hospital of Jiangsu University from January 2017 to August 2023, this retrospective cross-sectional study involved 4782 OPFs patients requiring hospitalization or surgery; after applying the exclusion criteria, the actual valid sample size used for analysis was 712 patients. The patient\u2019s serum HDL levels were determined, followed by the assessment of the procollagen type I N-terminal propeptide (P1NP) and the beta-C-terminal telopeptide of type I collagen (\u03b2-CTX) as outcome variables. Adjustments were made for age, gender, body mass index (BMI), and other clinical variables. The association between HDL and P1NP and \u03b2-CTX was analyzed using generalized estimating equations (GEE). Nonlinear associations were assessed via generalized additive models (GAM), with stratified analyses and threshold assessments conducted for result validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A negative association was found between HDL levels and both \u03b2-CTX and P1NP. After adjusting for covariates, each unit increase in HDL corresponded to a decrease in P1NP by 14.37 (\u03b2 = -14.37, 95% CI: -24.21 to -4.51,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.01) and in \u03b2-CTX by 0.14 (\u03b2 = -0.14, 95% CI: -0.22 to -0.06,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.01). Threshold analysis revealed a linear relationship between P1NP and \u03b2-CTX.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings reveal a negative correlation between HDL levels and both \u03b2-CTX and P1NP, suggesting a potential link between lipid metabolism and bone turnover. If validated in further studies, HDL could emerge as a predictive marker for BTMs, offering novel perspectives for osteoporosis management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1736832","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T05:44:27Z","timestamp":1770788667000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Association of high-density lipoprotein with P1NP and \u03b2-CTX in hospitalized patients with osteoporotic fractures: a retrospective cross-sectional study"],"prefix":"10.3389","volume":"17","author":[{"given":"Cheng-bai","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin-lin","family":"Wei","sequence":"additional","affiliation":[{"name":"Kunshan Municipal Health and Family Planning Information Center","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Jin","sequence":"additional","affiliation":[{"name":"Kunshan Municipal Health and Family Planning Information Center","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-bin","family":"Hu","sequence":"additional","affiliation":[{"name":"Chronic Disease Department, Kunshan Center for Disease Control and Prevention","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-jun","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1016\/j.jtcme.2017.07.004","article-title":"Evaluation of selected traditional Chinese medical extracts for bone mineral density maintenance: A mechanistic study","volume":"9","author":"Rebhun","year":"2019","journal-title":"J Tradit Compl Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1186\/s13018-023-03545-7","article-title":"Deciphering the protective effect of Buzhong Yiqi Decoction on osteoporotic fracture through network pharmacology and experimental validation","volume":"18","author":"Hua","year":"2023","journal-title":"J Orthop Surg Res"},{"key":"B3","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1186\/s12889-020-8292-x","article-title":"Applying the information-motivation-behavioral model to explore the influencing factors of self-management behavior among osteoporosis patients","volume":"20","author":"Tsamlag","year":"2020","journal-title":"BMC Public Health"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3390\/molecules22122068","article-title":"Live fluorescent staining platform for drug-screening and mechanism-analysis in Zebrafish for bone mineralization","volume":"22","author":"Chen","year":"2017","journal-title":"Molecules"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1077058","article-title":"Mitochondrial quality control and its role in osteoporosis","volume":"14","author":"Yan","year":"2023","journal-title":"Front Endocrinol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1119774","article-title":"Air pollution, genetic factors and the risk of osteoporosis: A prospective study in the UK biobank","volume":"11","author":"Yu","year":"2023","journal-title":"Front Public Health"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1171","DOI":"10.2147\/CIA.S257166","article-title":"Comparison of OSTA, FRAX and BMI for predicting postmenopausal osteoporosis in a Han population in Beijing: A cross sectional study","volume":"15","author":"Fan","year":"2020","journal-title":"Clin Interv Aging"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1038\/s41418-019-0453-z","article-title":"Tumor suppressor ZHX2 inhibits NAFLD-HCC progression via blocking LPL-mediated lipid uptake","volume":"27","author":"Wu","year":"2020","journal-title":"Cell Death Differ"},{"key":"B9","doi-asserted-by":"publisher","first-page":"9359429","DOI":"10.1155\/2022\/9359429","article-title":"High-fat diet increases bone loss by inducing ferroptosis in osteoblasts","volume":"2022","author":"Zhu","year":"2022","journal-title":"Stem Cells Int"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2478","DOI":"10.1093\/eurheartj\/ehx163","article-title":"Extreme high high-density lipoprotein cholesterol is paradoxically associated with high mortality in men and women: two prospective cohort studies","volume":"38","author":"Madsen","year":"2017","journal-title":"Eur Heart J"},{"key":"B11","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1007\/s11657-019-0579-0","article-title":"Association between serum high-density lipoprotein cholesterol and bone health in the general population: a large and multicenter study","volume":"14","author":"Jiang","year":"2019","journal-title":"Arch Osteoporos"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.2196\/40179","article-title":"Interpretable deep-learning approaches for osteoporosis risk screening and individualized feature analysis using large population-based data: model development and performance evaluation","volume":"25","author":"Suh","year":"2023","journal-title":"J Med Internet Res"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1598","DOI":"10.1097\/CORR.0000000000001685","article-title":"Can a deep-learning model for the automated detection of vertebral fractures approach the performance level of human subspecialists","volume":"479","author":"Li","year":"2021","journal-title":"Clin Orthop Relat R"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1785","DOI":"10.2147\/DMSO.S248844","article-title":"Effects of glycated hemoglobin level on bone metabolism biomarkers in patients with type 2 diabetes mellitus","volume":"13","author":"Zhao","year":"2020","journal-title":"Diabetes Metab Synd OB"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.891363","article-title":"Role of fracture risk assessment tool and bone turnover markers in predicting all-cause and cardiovascular mortality in hemodialysis patients","volume":"9","author":"Wu","year":"2022","journal-title":"Front Med-Lausanne"},{"key":"B16","doi-asserted-by":"publisher","first-page":"201","DOI":"10.2147\/CIA.S145741","article-title":"Comparison of three tools for predicting primary osteoporosis in an elderly male population in Beijing: a cross-sectional study","volume":"13","author":"Zhang","year":"2018","journal-title":"Clin Interv Aging"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1002\/jbmr.3471","article-title":"Bone turnover markers are not associated with hip fracture risk: A case-control study in the women\u2019s health initiative","volume":"33","author":"Crandall","year":"2018","journal-title":"J Bone Miner Res"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1530\/EC-21-0484","article-title":"Thyroid and bone turnover markers in type 2 diabetes: results from the METAL study","volume":"11","author":"Chen","year":"2022","journal-title":"Endocr Connect"},{"key":"B19","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1302\/2046-3758.114.BJR-2021-0226.R1","article-title":"Bone turnover markers as surrogates of fracture healing after intramedullary fixation of tibia and femur fractures","volume":"11","author":"Stewart","year":"2022","journal-title":"Bone Joint Res"},{"key":"B20","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1186\/1471-2261-14-113","article-title":"Comparison of various formulae for estimating low-density lipoprotein cholesterol by a combination of ages and genders in Taiwanese adults","volume":"14","author":"Tsai","year":"2014","journal-title":"BMC Cardiovasc Disor"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1215","DOI":"10.1093\/eurjhf\/hft084","article-title":"Anti-oxidative and cholesterol efflux capacities of high-density lipoprotein are reduced in ischaemic cardiomyopathy","volume":"15","author":"Patel","year":"2013","journal-title":"Eur J Heart Fail"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1442","DOI":"10.1359\/jbmr.080413","article-title":"Effects of PTH and alendronate on type I collagen isomerization in postmenopausal women with osteoporosis: the PaTH study","volume":"23","author":"Garnero","year":"2008","journal-title":"J Bone Miner Res"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2024.1404152","article-title":"Association between systemic inflammatory response index and bone turnover markers in Chinese patients with osteoporotic fractures: a retrospective cross-sectional study","volume":"11","author":"Zhou","year":"2024","journal-title":"Front Med-Lausanne"},{"key":"B24","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s12944-024-02023-1","article-title":"Association between high-density lipoprotein cholesterol and lumbar bone mineral density in Chinese: a large cross-sectional study","volume":"23","author":"Sun","year":"2024","journal-title":"Lipids Health Dis"},{"key":"B25","doi-asserted-by":"publisher","first-page":"5792","DOI":"10.1038\/s41598-023-32885-x","article-title":"The correlation between high-density lipoprotein cholesterol and bone mineral density in adolescents: a cross-sectional study","volume":"13","author":"Wang","year":"2023","journal-title":"Sci Rep-UK"},{"key":"B26","doi-asserted-by":"publisher","first-page":"R95","DOI":"10.1530\/JOE-16-0657","article-title":"High-density lipoprotein (HDL) metabolism and bone mass","volume":"233","author":"Papachristou","year":"2017","journal-title":"J Endocrinol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1159\/000521288","article-title":"Charlson comorbidity index: A critical review of clinimetric properties","volume":"91","author":"Charlson","year":"2022","journal-title":"Psychother Psychosom"},{"key":"B28","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1007\/s00198-023-06905-5","article-title":"A novel fracture liaison service using digital health: impact on mortality in hospitalized elderly osteoporotic fracture patients","volume":"35","author":"Lu","year":"2024","journal-title":"Osteoporosis Int"},{"key":"B29","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1007\/s12072-013-9457-9","article-title":"The effects of intraoperative cryoprecipitate transfusion on acute renal failure following orthotropic liver transplantation","volume":"7","author":"Liu","year":"2013","journal-title":"Hepatol Int"},{"key":"B30","doi-asserted-by":"publisher","first-page":"10126","DOI":"10.1111\/jcmm.16949","article-title":"Bisphosphonate-enoxacin inhibit osteoclast formation and function by abrogating RANKL-induced JNK signalling pathways during osteoporosis treatment","volume":"25","author":"Xu","year":"2021","journal-title":"J Cell Mol Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"CD3376","DOI":"10.1002\/14651858.CD003376.pub4","article-title":"Etidronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women","volume":"4","author":"Wells","year":"2024","journal-title":"Cochrane DB Syst Rev"},{"key":"B32","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1007\/s11914-011-0051-6","article-title":"The role of bone marrow and visceral fat on bone metabolism","volume":"9","author":"Sheu","year":"2011","journal-title":"Curr Osteoporos Rep"},{"key":"B33","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.jshs.2017.09.009","article-title":"Bone mineral density in lifelong trained male football players compared with young and elderly untrained men","volume":"7","author":"Hagman","year":"2018","journal-title":"J Sport Health Sci"},{"key":"B34","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1186\/s13018-022-02986-w","article-title":"Positive association between high-density lipoprotein cholesterol and bone mineral density in U.S. adults: the NHANES 2011-2018","volume":"17","author":"Xie","year":"2022","journal-title":"J Orthop Surg Res"},{"key":"B35","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/1472-6823-14-14","article-title":"Association of calcaneal quantitative ultrasound parameters with metabolic syndrome in middle-aged and elderly Chinese: a large population-based cross-sectional study","volume":"14","author":"Sun","year":"2014","journal-title":"BMC Endocr Disord"},{"key":"B36","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1186\/s12933-019-0888-z","article-title":"Lipoprotein (a) interactions with cholesterol-containing lipids on angiographic coronary collateralization in type 2 diabetic patients with chronic total occlusion","volume":"18","author":"Shen","year":"2019","journal-title":"Cardiovasc Diabetol"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab146","article-title":"Identification and functional characterization of metabolites for bone mass in peri- and postmenopausal Chinese Women","volume":"106","author":"Gong","year":"2021","journal-title":"J Clin Endocr Metab"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2022.934951","article-title":"The role of metabolites under the influence of genes and lifestyles in bone density changes","volume":"9","author":"Lv","year":"2022","journal-title":"Front Nutr"},{"key":"B39","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/s13018-022-03491-w","article-title":"Effects of vitamin D deficiency on blood lipids and bone metabolism: a large cross-sectional study","volume":"18","author":"Gu","year":"2023","journal-title":"J Orthop Surg Res"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2018.00646","article-title":"Association between bone mineral density, bone turnover markers, and serum cholesterol levels in type 2 diabetes","volume":"9","author":"Yang","year":"2018","journal-title":"Front Endocrinol"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1042\/BSR20181505","article-title":"Associations between polymorphisms of the PDLIM4 gene and susceptibility to osteoporotic fracture in an elderly population of Han Chinese","volume":"39","author":"Chen","year":"2019","journal-title":"Bioscience Rep"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.3390\/nu14061205","article-title":"Relationships between bone turnover markers and factors associated with metabolic syndrome in prepubertal girls and boys","volume":"14","author":"Bilinski","year":"2022","journal-title":"Nutrients"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1016\/j.sjbs.2019.04.010","article-title":"Effect of cervus and cucumis polypeptide combined with zoledronic acid on bone metabolic biochemical markers in glucocorticoids - Induced osteoporosis patients","volume":"26","author":"Han","year":"2019","journal-title":"Saudi J Biol Sci"},{"key":"B44","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1111\/os.12427","article-title":"Effects of acupoint application therapy with TianGui powder on osteoporosis in ovariectomized rats through TGF-\u03b21 and Smad2\/3 signaling pathway","volume":"11","author":"Lin","year":"2019","journal-title":"Orthop Surg"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics12010096","article-title":"Premenopausal Singaporean women suffering from major depressive disorder treated with selective serotonin reuptake inhibitors had similar bone mineral density as compared with healthy controls","volume":"12","author":"Ho","year":"2022","journal-title":"Diagnostics"},{"key":"B46","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1186\/s12891-023-06147-w","article-title":"Differences in the prevalence and risk factors of osteoporosis in chinese urban and rural regions: a cross-sectional study","volume":"24","author":"Zheng","year":"2023","journal-title":"BMC Musculoskel Dis"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000033833","article-title":"A nomogram for predicting osteoarthritis based on serum biomarkers of bone turnover in middle age: A cross-sectional study of PTH and \u03b2-CTx","volume":"102","author":"Chen","year":"2023","journal-title":"Medicine"},{"key":"B48","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1186\/s13018-020-02065-y","article-title":"Degradation of subchondral bone collagen in the weight-bearing area of femoral head is associated with osteoarthritis and osteonecrosis","volume":"15","author":"Wu","year":"2020","journal-title":"J Orthop Surg Res"},{"key":"B49","doi-asserted-by":"publisher","first-page":"2562","DOI":"10.1210\/jc.2013-1047","article-title":"Abdominal fat is associated with lower bone formation and inferior bone quality in healthy premenopausal women: a transiliac bone biopsy study","volume":"98","author":"Cohen","year":"2013","journal-title":"J Clin Endocr Metab"},{"key":"B50","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1093\/jn\/nxy040","article-title":"Diets low in saturated fat with different unsaturated fatty acid profiles similarly increase serum-mediated cholesterol efflux from THP-1 macrophages in a population with or at risk for metabolic syndrome: the canola oil multicenter intervention trial","volume":"148","author":"Liu","year":"2018","journal-title":"J Nutr"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.864299","article-title":"Menopausal transition: prospective study of estrogen status, circulating microRNAs, and biomarkers of bone metabolism","volume":"13","author":"Baloun","year":"2022","journal-title":"Front Endocrinol"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.931231","article-title":"Changes in vertebral marrow fat fraction using 3D fat analysis & Calculation technique imaging sequence in aromatase inhibitor-Treated breast cancer women","volume":"13","author":"Wan","year":"2022","journal-title":"Front Endocrinol"},{"key":"B53","doi-asserted-by":"publisher","first-page":"3039","DOI":"10.2147\/DMSO.S372348","article-title":"Prevalence and risk factors of osteoporosis in patients with type 2 diabetes mellitus in Nanchang (China): A retrospective cohort study","volume":"15","author":"Li","year":"2022","journal-title":"Diabetes Metab Synd Ob"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1736832\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:22:36Z","timestamp":1771928556000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1736832\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,11]]},"references-count":53,"alternative-id":["10.3389\/fendo.2026.1736832"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1736832","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,11]]},"article-number":"1736832"}}