European Journal of Epidemiology

, Volume 19, Issue 12, pp 1105–1112 | Cite as

Atherogenic lipid profile and elevated lipoprotein (a) are associated with lower bone mineral density in early postmenopausal overweight women

  • Pilar Orozco


Epidemiological studies have reported that women with osteoporosis present an increased risk of cardiovascular events and that lipid lowering therapy (statins) could be associated with a decreased risk of fracture. We investigated whether women with atherogenic lipid profile have lower lumbar and femoral bone mineral density (BMD) and higher prevalence of osteopenia than those with normal lipid levels. The study included 52 overweight early postmenopausal women, with no history of hormone replacement therapy, or any current or past pathology or treatment that could alter bone or lipid metabolism. Atherogenic lipid profile or hyperlipidemia was defined as hypercholesterolemia (⩾240 mg/dl) or high low-density lipoprotein cholesterol (high-LDLc ⩾160 mg/dl) or high lipoprotein (a) [high-Lp (a) ⩾25 mg/dl], and low-BMD as t-score <−1 SD at lumbar o femoral site. The results show that women with hyperlipidemia had lower mean-adjusted BMD (mean ± SEM) at lumbar (0.865 ± 0.020 vs. 0.958 ± 0.028 g/cm2, p=0.007) and femoral neck (0.712 ± 0.015 vs. 0.796 ± 0.021, p=0.004 g/cm2) than those with normal lipid levels. Hypercholesterolemia group had higher prevalence of low-BMD at lumbar spine (82.6% vs. 55.2%, p=0.04, or 3.8; 95% CI: 1.04–14.2) and femoral neck (65.2% vs. 37.9%, p=0.05, OR: 3.1; 95% CI: 0.98–9.6). The high-LDLc group had also higher prevalence low-BMD at femoral neck (75% vs. 39%, p=0.01, OR: 4.7; 95% CI: 1.26–17.5), and the high-Lp (a) group at lumbar spine (87% vs. 51.7% p=0.007, OR: 6.2; 95% CI: 1.5–25.6). Women with hyperlipidemia had higher prevalence of low BMD at lumbar spine (81.8% vs. 42.1%, p=0.003, OR: 6.2; 95% CI: 1.7–22) and femoral neck (60.6% vs. 31.6%, p=0.04, OR: 3.3; 95% CI: 1.01–11.0). In conclusion, early postmenopausal women with atherogenic lipid profile, defined as cholesterol ⩾240 mg/dl or LDLc ⩾160 mg/dl or Lp(a) ⩾25 mg/dl have lower lumbar and femoral BMD and have an increased risk of osteopenia than those with normal lipid profile, suggesting that hyperlipidemia could be associated with osteoporosis and bone status should be evaluated in women with hyperlipidemia.


Bone mineral density Cholesterol Hyperlipidemia Lipoprotein (a) Risk factor Osteoporosis 


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  1. Von der Recke, P, Hansen, MA, Hassager, C 1999The association between low bone mass at the menopause and cardiovascular mortalityAm J Med106273278CrossRefPubMedGoogle Scholar
  2. Browner, WS, Seeley, DG, Vogt, TM, Cummings, SR 1991Non-trauma mortality in elderly women with low bone mineral density. Study of osteoporotic fractures research groupLancet338355358PubMedGoogle Scholar
  3. Browner, WS, Pressman, AR, Nevitt, MC, Cauley, JA, Cummings, SR 1993Association between low bone density and stroke in elderly women. The study of osteoporotic fracturesStroke24940946PubMedGoogle Scholar
  4. Uyama, O, Yoshimoto, Y, Yamamoto, Y, Kawai, A 1997Bone changes and carotid atherosclerosis in postmenopausal womenStroke2817301732PubMedGoogle Scholar
  5. Barengolts, EI, Berman, M, Kukreja, SC, Kouznetsova, T, Lin, C, Chomka, EV 1998Osteoporosis and coronary atherosclerosis in asymptomatic postmenopausal womenCalcif Tissue Int62209213CrossRefPubMedGoogle Scholar
  6. Broulik, PD, Kapitola, J 1993Interrelations between body weight, cigarette smoking and spine mineral density in osteoporotic Czech womenEndocr Reg275760Google Scholar
  7. Zabaglia, SF, Pedro, A, Pinto Neto, AM, Guarisi, T, Paiva, LH, Lane, E 1998Estudo exploratório da associaçao entre o perfil lipídico e a densidade mineral óssea em mulheres menopausadas, em hospital de referencia de CampinasCad Saude Publica14779786PubMedCrossRefGoogle Scholar
  8. Tankó, LB, Bagger, YZ, Nielsen, SB, Christiansen, C 2003Does serum cholesterol contribute to vertebral bone loss in postmenopausal women?Bone32814PubMedGoogle Scholar
  9. Edwards, CJ, Hart, DJ, Spector, TD 2000Oral statins and increased bone mineral density in postmenopausal womenLancet35522182219PubMedGoogle Scholar
  10. Chan, KA, Andrade, SE, Boles, M, Buist, DSM, Chase, GA, Donahue, JD, Goodman, MJ, Gurwitz, JH, LaCroix, AZ, Platt, R 2000Inhibitors of hydroxymethylglutaryl-coenzyme A reductase and risk of fracture among older womenLancet35521852188PubMedGoogle Scholar
  11. Wang, PS, Solomon, DH, Mogun, H, Avorn, J 2000HMG-CoA reductase inhibitors and the risk of hip fractures in elderly patientsJAMA28332113216CrossRefPubMedGoogle Scholar
  12. Meier, CR, Schlienger, RG, Kraenzlin, ME, Schlegel, B, Jick, H 2000HMG-CoA reductase inhibitors and the risk of fracturesJAMA28332053210CrossRefPubMedGoogle Scholar
  13. Pasco, JA, Kotowicz, MA, Henry, MJ, Sanders, KM, Nicholson, GC 2002Statin use, bone mineral density, and fracture riskArch Intern Med162537540PubMedGoogle Scholar
  14. Amin, D, Cornell, SA, Gustafson, SK, Needle, SJ, Ullrich, JW, Bilder, GE, Perrone, MH 1992Bisphosphonates used for the treatment of bone disorders inhibits squalene synthase and cholesterol biosynthesisJ Lipid Res3316571663PubMedGoogle Scholar
  15. Bergstrom, JD, Bostedor, RG, Masarachia, PJ, Reszka, AA, Rodan, G 2000Alendronate is a specific, nanomolar inhibitor of farnesyl diphosphate synthaseArch Biochem Biophys373231241CrossRefPubMedGoogle Scholar
  16. Díaz-Curiel, MDiez-Pérez, AGómez-Alonso, C eds. 1996Nuevas fronteras en el estudio de la densidad ósea en la población españolaEd EdimsaMadrid83Google Scholar
  17. Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult treatment panel III). JAMA 2001; 285: 2486–2497.Google Scholar
  18. Koshiyama, H, Wada, Y, Nakamura, Y 2001Hypercholesterolemia as a possible risk factor for osteopenia in type 2 diabetes mellitusArch Inter Med16116781678CrossRefGoogle Scholar
  19. Recker, R, Lappe, J, Daies, K, Heany, R 2000Characterization of perimenopausal bone loss: a prospective studyJ Bone Miner Res1519651973PubMedGoogle Scholar
  20. Cummings, SR, Bauer, DC 2000Do statins prevent both cardiovascular disease and fracture?JAMA28332553257PubMedGoogle Scholar
  21. Varenna, M, Binelli, L, Zucchi, F, Ghringhelli, D, Sinigaglia, L 2001Unbalanced diet to lower serum cholesterol level is a risk factor for postmenopausal osteoporosis and distal forearm fractureOsteoporos Int12296301CrossRefPubMedGoogle Scholar
  22. Reid, IR, Mason, B, Horne, A, Ames, R, Clearwater, J, Bava, U, Orr-Walker, B, Wu, F, Evans, MC, Gamble, GD 2002Effects of calcium supplementation on serum lipid concentrations in normal older women: a randomized controlled trialAm J Med112343347CrossRefPubMedGoogle Scholar
  23. Wilmink, HW, de Kleijn, MJJ, Bots, ML, Bak, AAA, van der Schouw, YT, Engelen, S, Planellas, J, Banga, JD, Grobbee, DE 2000Lipoprotein (a) is associated with endothelial function in healthy postmenopausal womenAtherosclerosis153249254CrossRefPubMedGoogle Scholar
  24. Parhami, F, Morrow, AD, Balucan, J, Leitinger, N, Watson, AD, Tintut, Y, Berliner, JA, Demer, LL 1997Lipid oxidation products have opposite effects on calcifying vascular cell and bone cell differentiation. A possible explanation for the paradox of arterial calcification in osteoporotic patientsArteriocler Thromb Vasc Biol17680687Google Scholar
  25. Enriquez, L, Matas, P 2001Lipoproteina (a): Fisiopatología y consideraciones clínicas y terapeúticasMed Clin (Barc)116746749Google Scholar
  26. Abbey, M, Owen, A, Suzakawa, M, Roach, P, Netel, PJ 1999Effects of menopause and hormone replacement therapy on plasma lipids, lipoproteins and LDL-receptor activityMaturitas33259269CrossRefPubMedGoogle Scholar
  27. Kim, CJ, Jang, HC, Cho, DH, Min, YK 1994Effects of hormone replacement therapy on lipoprotein(a) and lipids in postmenopausal womenArterioscl Thromb87709720Google Scholar
  28. Alsaeid, M, Qabazard, M, Shaltout, A, Sharma, PN 2001Impact of glycemic control on serum lipoprotein (a) in Arab children with type 1 diabetesPediatr Int43246250CrossRefPubMedGoogle Scholar
  29. Shi, H, Fang, J, Yang, X, Shen, Z, Zhu, X 1998Lipoprotein (a) concentration and apolipoprotein (a) phenotype in subjects with type 2 diabetes mellitusChin Med (Engl)11110131017Google Scholar
  30. Schwaninger, M, Ringleb, P, Annecke, A, Winter, R, Khol, B, Werle, E, Fiehn, W, Rieser, PA, Walter-Sack, I 2000Elevated plasma concentrations of lipoprotein (a) in medicated epileptic patientsJ Neurol247687690CrossRefPubMedGoogle Scholar
  31. Mady, E, Wissa, G, Khallifa, A, el-Sabbagh, M 1999Serum lipoprotein (a) levels in chronic renal failure and liver cirrhosis patientsDis Markers15237247PubMedGoogle Scholar
  32. Godsland, IF 2001Effects of postmenopausal hormone replacement therapy on lipid, lipoprotein, and apolipoprotein (a) concentrations: analysis of studies published from 1974–2000Fertil Steril75898915CrossRefPubMedGoogle Scholar
  33. Decensi, A, Robertson, C, Ballardini, B, Paggi, D, Guerrieri-Gonzaga, A, Bonanni, B, Manetti, L, Johansson, H, Barreca, A, Battega, D, Costa, A 1999Effect of tamoxifen on lipoprotein (a) and insulin-like growth factor-I (IGF-I) in healthy womenEur J Cancer35596600CrossRefPubMedGoogle Scholar
  34. Akanji, AO, al-Shayji, IA, Kumar, P 1999Metabolic and anthropometric determinants of serum Lp(a) concentrations and Apo(a) polymorphism in a healthy Arab populationInt J Obes23855862CrossRefGoogle Scholar
  35. Pennisi, P, Signorelli, SS, Riccobene, S, Celotta, G, Di Pino, L, La Malfa, T, Fiore, CE 2004Low bone density and abnormal bone turnover in patients with atherosclerosis of peripheral vesselsOsteoporos Int15389395CrossRefPubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  1. 1.CAP Gòtic, Department of Family MedicineUniversity of BarcelonaBarcelonaSpain

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