Association of lipid metabolism and musculoskeletal fatty infiltration with the risk and severity of osteoporotic vertebral compression fractures in postmenopausal women: A retrospective study

Abstract

Objective

This study aimed to investigate the associations of multi-dimensional lipid metabolism indicators, comprising serum lipid profiles and the degree of fatty infiltration in the musculoskeletal system, with bone mineral density (BMD) and bone turnover markers (BTMs), and to identify independent risk factors for the occurrence and severity of osteoporotic vertebral compression fractures (OVCFs) in postmenopausal women.

Methods

This retrospective study included a total of 133 postmenopausal women from January 2023 to July 2024. Participants were stratified by fracture status and vertebral compression severity. Clinical data, including bone and lipid metabolic indicators and BMD, were retrieved from electronic medical records and MRI reanalysis. Pearson correlation analyzed associations between lipid metabolic indicators and BTMs/BMD. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for OVCFs, with multicollinearity among variables assessed using the variance inflation factor (VIF), and ordinal logistic regression was applied to assess lipid metabolic indicators’ impact on vertebral compression severity. Statistical analyses included Student's t-test or Mann-Whitney U test for group comparisons and one-way analysis of variance (ANOVA) for multiple-group comparisons.

Result

This study included 133 participants: 34 controls, 32 with mild, 38 with moderate, and 29 with severe fractures. Age, BMI, BMD, vertebral bone quality (VBQ), the fatty infiltration ratio of the paraspinal muscles (FIR), and lipoprotein(a) [Lp(a)] differed significantly between fracture and control groups (all p < 0.05). VBQ and FIR were negatively correlated with total BMD (r = -0.466, p < 0.05; r = -0.455, p < 0.05) and positively correlated with the ratio of the fractured vertebra compressed sagittal cross-sectional area (RCSA) (r = 0.344, p < 0.05; r = 0.320, p < 0.05) and age (r = 0.615, p < 0.05; r = 0.283, p < 0.05). Univariate and multivariate regression analyses indicated that VBQ (p = 0.043; OR = 4.260, 95% CI: 1.046–17.345), FIR (p = 0.047; OR = 2.372, 95% CI: 1.010–5.572), and Lp(a) (p = 0.048; OR = 1.002, 95% CI: 1.002–1.799) were independently associated with an increased risk of OVCFs. Ordinal logistic regression confirmed VBQ (p = 0.006; OR = 3.168, 95% CI: 1.378–7.282) and FIR (p = 0.034; OR = 1.156, 95% CI: 1.009–1.325) were associated with increased fracture severity.

Conclusion

VBQ and FIR were independently associated with osteoporotic fractures in postmenopausal women and were further linked to fracture severity, suggesting their potential value in risk stratification and fracture severity assessment. Although Lp(a) showed a statistically significant association with OVCFs, the association was relatively weak, and its clinical significance requires further validation.