Non-HDL to HDL cholesterol ratio as a potential biomarker for osteoporosis: A cross-sectional national population study

This cross-sectional study aimed to investigate the association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and osteoporosis (OP) among US women. An analysis was conducted using data from 6149 women participating in the National Health and Nutrition Examination Survey (NHANES). Weighted multivariable logistic regression and restricted cubic spline models were applied to evaluate the relationship between NHHR and OP, with adjustments for sociodemographic, clinical, and metabolic covariates. After full adjustment, a significant U-shaped relationship was identified between NHHR and osteoporosis prevalence, with an inflection point at NHHR = 3.371. Below this threshold, each unit increase in NHHR was associated with a 29% reduction in OP risk (odds ratio = 0.71, 95% confidence intervals: 0.60–0.84, P < .001). No significant association was observed above this value. Inverse associations were particularly notable in women aged ≥65 years, non-Hispanic Whites, former smokers, and those with higher education or lower physical activity levels. Non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio demonstrates a nonlinear, threshold-dependent association with osteoporosis risk, supporting its potential role as a novel biomarker for OP in specific subpopulations. Further prospective studies are warranted to clarify causal mechanisms.