Evidence mapPaperPMID 42470013Full record

ArticleMedicine2026

Inverse association between high-density lipoprotein cholesterol and bone mineral density in patients with diabetes results from a nationally representative survey.

Yi Tang, Xia Li, Jiewen Wei, Jiale Liu, Yunhao Wang, Hongxing Liao

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Article in Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

6 authors.

Yi TangThe First School of Clinical Medicine, Guangdong Medical University, Zhanjiang, China.
Xia LiDepartment of Sports Medicine, Affiliated Meizhou Hospital of Shantou University Medical College, Meizhou, China.ORCID 0009-0006-7975-8878
Jiewen WeiDepartment of Hand Surgery, Huizhou Sixth People's Hospital, Huizhou, China.
Jiale LiuThe First School of Clinical Medicine, Guangdong Medical University, Zhanjiang, China.
Yunhao WangDepartment of Sports Medicine, Affiliated Meizhou Hospital of Shantou University Medical College, Meizhou, China.ORCID 0009-0002-3083-7621
Hongxing LiaoThe First School of Clinical Medicine, Guangdong Medical University, Zhanjiang, China.

Funding

Cultivation Program of Meizhou People’s Hospital No. PY-C 2025014Meizhou Social Development Science and Technology Plan Project No. 2022C0301026
6 · The paper itself

Abstract

Diabetes mellitus substantially increases the risk of osteoporosis and fractures, but the mechanisms remain unclear. Dyslipidemia, particularly the role of high-density lipoprotein (HDL), may influence bone mineral density (BMD), yet evidence in diabetic patients is limited. This study aimed to explore the association between HDL and BMD in US adults with diabetes using a nationally representative dataset. We analyzed data from 5 National Health and Nutrition Examination Survey cycles (2005-2018). A total of 5014 diabetic participants with available HDL and dual-energy X-ray absorptiometry (DXA)-measured BMD were included. Weighted multivariable linear regression models, smooth curve fitting, and 2-piecewise linear regression were employed to examine linear and nonlinear associations. Subgroup and sensitivity analyses were also conducted to assess robustness. Among 5014 participants (mean age 40.1 ± 31.2 years; 50.8% male), mean femoral neck and lumbar spine BMD were 0.81 and 1.03 g/cm2, respectively, with a mean HDL of 48.9 mg/dL. Higher HDL levels were inversely associated with BMD at both the femoral neck (β = -0.0011, 95% CI: -0.0015 to -0.0007) and lumbar spine (β = -0.0012, 95% CI: -0.0018 to -0.0007) after full adjustment. Participants in the highest HDL quartile had significantly lower BMD compared with those in the lowest quartile (femoral neck: -0.0294 g/cm2; lumbar spine: -0.0378 g/cm2). Smooth curve fitting indicated nonlinear, negative associations. Subgroup analyses revealed stronger inverse associations in men, participants with hypertension, those <60 years at the femoral neck, and those ≥60 years at the lumbar spine. Sensitivity analyses confirmed the robustness of the results. Higher HDL levels were consistently and independently associated with lower BMD in US adults with diabetes. These findings challenge the traditional view of HDL as universally protective, suggesting that in the diabetic context, elevated HDL may exert detrimental effects on bone health. Further longitudinal and mechanistic studies are warranted to clarify causal pathways and guide osteoporosis prevention strategies in this high-risk population.

Indexed as

Bone DensityCholesterol, HDLDiabetes MellitusAbsorptiometry, PhotonAdultFemaleFemur NeckHumansLumbar VertebraeMaleMiddle AgedNutrition SurveysOsteoporosisRisk FactorsUnited StatesCholesterol, HDLbone mineral densitydiabetes mellitushigh-density lipoproteinNHANESosteoporosis

Identifiers

PMID42470013
PMCPMC13384549

What Socratic holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.