Triglyceride Levels and Fracture Risk in Midlife Women: Study of Women's Health Across the Nation (SWAN).
Unfavorable lipid levels contribute to cardiovascular disease and may also harm bone health.



Our objective was to investigate relationships between fasting plasma lipid levels and incident fracture in midlife women undergoing the menopausal transition.



This was a 13-year prospective, longitudinal study of multiethnic women in five US communities, with near-annual assessments.



At baseline, 2062 premenopausal or early perimenopausal women who had no history of fracture were included.



Fasting plasma total cholesterol, triglycerides (TG), low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol at baseline and follow-up visits 1 and 3-7.



Incident nontraumatic fractures 1) 2 or more years after baseline, in relation to a single baseline level of lipids; and 2) 2-5 years later, in relation to time-varying lipid levels. Cox proportional hazards modelings estimated hazard ratios and 95% confidence interval (CI).



Among the lipids, TG levels changed the most, with median levels increased by 16% during follow-up. An increase of 50 mg/dl in baseline TG level was associated with a 1.1-fold increased hazards of fracture (adjusted hazard ratio, 1.11; 95% CI, 1.04-1.18). Women with baseline TG higher than 300 mg/dl had an adjusted 2.5-fold greater hazards for fractures (95% CI, 1.13-5.44) than women with baseline TG lower than 150 mg/dl. Time-varying analyses showed a comparable TG level-fracture risk relationship. Associations between total cholesterol, low-density lipoprotein cholesterol, or high-density lipoprotein cholesterol levels and fractures were not observed.



Midlife women with high fasting plasma TG had an increased risk of incident nontraumatic fracture. Secondary Abstract: Midlife women with fasting plasma triglyceride (TG) of at least 300 mg/dl had 2.5-fold greater hazards of fracture in 2 years later and onward, compared to those with TG below 150 mg/dl, in a multiethnic cohort. Time-varying analyses revealed comparable results.
Division of Endocrinology, Gerontology, and Metabolism (P.-Y.C., J.S.L.), Department of Medicine, Stanford University School of Medicine, Stanford, California; Department of Public Health Sciences (E.B.G.), University of California, Davis, Davis, California; Department of Epidemiology (J.A.C., K.M.R.), University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania; Department of Statistics (W.O.J.), University of California, Irvine, Irvine, California; 5Department of Epidemiology (C.K.-G.), University of Michigan School of Public Health, Ann Arbor, Michigan; Division of Cardiovascular Medicine (E.A.J.), Department of Medicine, University of Michigan Health Systems, Ann Arbor, Michigan; Medical Services (J.S.L.), Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
Po-Yin
PY
Chang
Division of Endocrinology, Gerontology, and Metabolism (P.-Y.C., J.S.L.), Department of Medicine, Stanford University School of Medicine, Stanford, California; Department of Public Health Sciences (E.B.G.), University of California, Davis, Davis, California; Department of Epidemiology (J.A.C., K.M.R.), University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania; Department of Statistics (W.O.J.), University of California, Irvine, Irvine, California; 5Department of Epidemiology (C.K.-G.), University of Michigan School of Public Health, Ann Arbor, Michigan; Division of Cardiovascular Medicine (E.A.J.), Department of Medicine, University of Michigan Health Systems, Ann Arbor, Michigan; Medical Services (J.S.L.), Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
Ellen B
EB
Gold
Division of Endocrinology, Gerontology, and Metabolism (P.-Y.C., J.S.L.), Department of Medicine, Stanford University School of Medicine, Stanford, California; Department of Public Health Sciences (E.B.G.), University of California, Davis, Davis, California; Department of Epidemiology (J.A.C., K.M.R.), University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania; Department of Statistics (W.O.J.), University of California, Irvine, Irvine, California; 5Department of Epidemiology (C.K.-G.), University of Michigan School of Public Health, Ann Arbor, Michigan; Division of Cardiovascular Medicine (E.A.J.), Department of Medicine, University of Michigan Health Systems, Ann Arbor, Michigan; Medical Services (J.S.L.), Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
Jane A
JA
Cauley
Division of Endocrinology, Gerontology, and Metabolism (P.-Y.C., J.S.L.), Department of Medicine, Stanford University School of Medicine, Stanford, California; Department of Public Health Sciences (E.B.G.), University of California, Davis, Davis, California; Department of Epidemiology (J.A.C., K.M.R.), University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania; Department of Statistics (W.O.J.), University of California, Irvine, Irvine, California; 5Department of Epidemiology (C.K.-G.), University of Michigan School of Public Health, Ann Arbor, Michigan; Division of Cardiovascular Medicine (E.A.J.), Department of Medicine, University of Michigan Health Systems, Ann Arbor, Michigan; Medical Services (J.S.L.), Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
Wesley O
WO
Johnson
Division of Endocrinology, Gerontology, and Metabolism (P.-Y.C., J.S.L.), Department of Medicine, Stanford University School of Medicine, Stanford, California; Department of Public Health Sciences (E.B.G.), University of California, Davis, Davis, California; Department of Epidemiology (J.A.C., K.M.R.), University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania; Department of Statistics (W.O.J.), University of California, Irvine, Irvine, California; 5Department of Epidemiology (C.K.-G.), University of Michigan School of Public Health, Ann Arbor, Michigan; Division of Cardiovascular Medicine (E.A.J.), Department of Medicine, University of Michigan Health Systems, Ann Arbor, Michigan; Medical Services (J.S.L.), Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
Carrie
C
Karvonen-Gutierrez
Division of Endocrinology, Gerontology, and Metabolism (P.-Y.C., J.S.L.), Department of Medicine, Stanford University School of Medicine, Stanford, California; Department of Public Health Sciences (E.B.G.), University of California, Davis, Davis, California; Department of Epidemiology (J.A.C., K.M.R.), University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania; Department of Statistics (W.O.J.), University of California, Irvine, Irvine, California; 5Department of Epidemiology (C.K.-G.), University of Michigan School of Public Health, Ann Arbor, Michigan; Division of Cardiovascular Medicine (E.A.J.), Department of Medicine, University of Michigan Health Systems, Ann Arbor, Michigan; Medical Services (J.S.L.), Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
Elizabeth A
EA
Jackson
Division of Endocrinology, Gerontology, and Metabolism (P.-Y.C., J.S.L.), Department of Medicine, Stanford University School of Medicine, Stanford, California; Department of Public Health Sciences (E.B.G.), University of California, Davis, Davis, California; Department of Epidemiology (J.A.C., K.M.R.), University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania; Department of Statistics (W.O.J.), University of California, Irvine, Irvine, California; 5Department of Epidemiology (C.K.-G.), University of Michigan School of Public Health, Ann Arbor, Michigan; Division of Cardiovascular Medicine (E.A.J.), Department of Medicine, University of Michigan Health Systems, Ann Arbor, Michigan; Medical Services (J.S.L.), Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
Kristine M
KM
Ruppert
Division of Endocrinology, Gerontology, and Metabolism (P.-Y.C., J.S.L.), Department of Medicine, Stanford University School of Medicine, Stanford, California; Department of Public Health Sciences (E.B.G.), University of California, Davis, Davis, California; Department of Epidemiology (J.A.C., K.M.R.), University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania; Department of Statistics (W.O.J.), University of California, Irvine, Irvine, California; 5Department of Epidemiology (C.K.-G.), University of Michigan School of Public Health, Ann Arbor, Michigan; Division of Cardiovascular Medicine (E.A.J.), Department of Medicine, University of Michigan Health Systems, Ann Arbor, Michigan; Medical Services (J.S.L.), Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
Jennifer S
JS
Lee
D000328:Adult; D015415:Biomarkers / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015228:Hypertriglyceridemia / Q000150:complications*; D008137:Longitudinal Studies; D008593:Menopause; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000097:blood / Q000209:etiology* / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood*; D016387:Women's Health
D015415:Biomarkers; D014280:Triglycerides