Nonlinear association of non-HDL-C/HDL-C with total trabecular bone score in adults: NHANES 2005-to-2008 study

The trabecular bone score (TBS) has been demonstrated to be significantly correlated with the mechanical strength of bones, thereby assisting in the prediction of fracture risk. Recently, the non-high-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio (NHHR) has become a new way to evaluate abnormalities in lipid metabolism. While some studies have examined the relationship of NHHR to bone mineral density (BMD) and osteoporosis, the evidence regarding its association with trabecular bone score (TBS) is inconclusive. The primary objective of this study was to examine the relationship between NHHR and TBS in a large group of adults, employing a cross-sectional study design. The investigation was predicated on adult NHHR and total TBS statistics from the 2005-2008 National Health and Nutrition Examination Survey (NHANES). We used covariate-adjusted multivariate linear regression models, smoothed curve-fitting analyses, and analyses of threshold and saturation effects to investigate the relationship between NHHR and total TBS. Subgroup analyses and interaction tests were used to determine the robustness of the results. In addition, we characterized the study population by dividing it into 4 groups based on NHHR quartiles. The findings of the study indicated a substantial negative correlation between NHHR and total TBS, with adjustments made for pertinent covariates. Participants in the lowest quartile demonstrated a decrease in total TBS of 0.019 (95% CI -0.027 to -0.010, P = .0076), in contrast to those in the highest quartile. Furthermore, a nonlinear relationship and a saturation effect were identified between NHHR and total TBS. The study identified an inflection point with a calculated value of 2.467. Subgroup analyses yielded consistent results across age, gender, and BMI subgroups. However, utility values exhibited variability between ethnic groups. The study's results indicate that adults exhibit a negative correlation between NHHR and total TBS and that this relationship is nonlinear with a saturation effect.