NHR levels in patients with osteoporosis associated with increased risk of fragility fracture: Study
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. The study by Wang et al explored whether NHR levels in patients with osteoporosis were associated with an increased risk of fragility fracture.
This case-control study included 271 osteoporotic patients with and without a history of fragility fracture. Laboratory tests and physical examinations were conducted in all participants, and NHR was calculated.
Key findings of the study were:
• 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).
• The authors 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.
The authors concluded that – “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.”
Further reading:
Association of neutrophil to high-density lipoprotein cholesterol ratio with fragility fracture in osteoporotic patients: a case-control study Wang et al. BMC Musculoskeletal Disorders (2025) 26:193 https://doi.org/10.1186/s12891-025-08440-2
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