Abstract
BACKGROUND: Systematic inflammation plays an important role in the pathogenesis of osteoporosis. Neutrophil to high-density lipoprotein cholesterol ratio (NHR) has been considered as a novel inflammatory marker. To date, the clinical association between NHR and fragility fracture is not yet well-known. Thus, the present study explored whether NHR levels in patients with osteoporosis were associated with an increased risk of fragility fracture. METHODS: This case-control study included 271 osteoporotic patients with and without a history of fragility fracture from January 2017 to December 2021. Laboratory tests and physical examinations were conducted in all participants, and NHR was calculated. RESULTS: The mean NHR levels in patients with fragility fractures were significantly higher compared to those without fragility fractures (2.91 ± 1.18 vs. 2.21 ± 0.91, P < 0.001). Additionally, there was a significant positive correlation between NHR and fragility fracture (r = 0.310, P < 0.001). Moreover, we could detect a statistical increment of the area under receiver operating characteristics curve (from 0.681 to 0.805, P < 0.001) upon the combination of NHR and Fracture Risk Assessment Tool (FRAX) score for determining the presence of fragility fracture among the study patients. In multivariable logistic regression models, elevated NHR level was an independent risk factor for fragility fracture (adjusted OR: 1.924, 95% CI: 1.443-2.564, P < 0.001) when adjusted for alkaline phosphatase and FRAX score. CONCLUSIONS: As a valuable and convenient inflammatory biomarker calculated from routine blood examinations, NHR might help to identify individuals with osteoporosis who are at high risk of fragility fracture.