Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2023; 14(9): 720-732
Published online Sep 18, 2023. doi: 10.5312/wjo.v14.i9.720
Relationships among body weight, lipids and bone mass in elderly individuals with fractures: A case-control study
Xiang-Xu Chen, Chu-Wei Tian, Li-Yong Bai, Ya-Kuan Zhao, Cheng Zhang, Liu Shi, Yuan-Wei Zhang, Wen-Jun Xie, Huan-Yi Zhu, Hui Chen, Yun-Feng Rui
Xiang-Xu Chen, Cheng Zhang, Liu Shi, Wen-Jun Xie, Hui Chen, Yun-Feng Rui, Department of Orthopaedics, Trauma Center, Southeast University, Nanjing 210009, Jiangsu Province, China
Chu-Wei Tian, Li-Yong Bai, Ya-Kuan Zhao, Yuan-Wei Zhang, Huan-Yi Zhu, Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
Author contributions: Chen XX and Tian CW contributed equally to this work; Chen XX and Tian CW designed the study, including the research questions and methodology; Bai LY, Zhao YK, Zhang C, Shi L, Zhang YW, Xie WJ, Zhu HY, Chen H asisted in study design, contributed to data collection and management; Tian CW performed data analysis, provided critical insights into data interpretation; Rui YF supervised the entire study, provided guidance on research design and took a lead in manuscript writing and revision; All authors have read and approve the final manuscript.
Supported by Jiangsu Elderly Health Research Project, No. LD2021010; Jiangsu Elderly Health Research Project, Key Project of Elderly Health Research Project, No. LKZ2022010; Open Project of National Key Professional Base for Standardized Training of Resident Physicians in Zhongda Hospital Affiliated to Southeast University, No. ZDZYJD-QK-2022-7.
Institutional review board statement: The study was reviewed and approved by the IEC for Clinical Research of Zhongda Hospital, Affiliated to Southeast University [Approval No.2022ZDSYLL183-P01].
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no competing financial interests or conflicts of interest that could have influenced the design, data collection, analysis, interpretation, or publication of this study.
Data sharing statement: The data presented in this study are available upon reasonable request to qualified researchers for the purpose of academic and scientific collaboration. Requests for data access should be directed to the corresponding author at ruiyunfeng@126.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yun-Feng Rui, MD, PhD, Chief Doctor, Deputy Director, Professor, Surgeon, Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Dingjiaqiao, Nanjing 210009, Jiangsu Province, China. ruiyunfeng@126.com
Received: July 6, 2023
Peer-review started: July 6, 2023
First decision: August 4, 2023
Revised: August 15, 2023
Accepted: August 29, 2023
Article in press: August 29, 2023
Published online: September 18, 2023

The prevalence of osteoporosis and low bone mass is steadily rising each year. Low body weight is commonly linked to diminished bone mass and serves as a robust predictor of osteoporosis. Nonetheless, the connection between body mass index (BMI), bone mineral density, and lipid profiles among the elderly remains elusive.


To examine the association between BMI and bone mass, explore the correlation between lipid profiles and bone mass, and delve into the interplay between lipid metabolism and bone health.


The study included 520 patients aged ≥ 65 years (178 men and 342 women). Age, sex, weight, and height were recorded. Femoral neck bone mineral density and T scores were determined using a dual-energy X-ray absorptiometry scanner. Blood calcium (Ca), phosphorus (P), albumin (ALB), alkaline phosphatase (ALP), aspartate aminotransferase, alanine aminotransferase, triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels were measured. Patients were classified by sex (male and female), age (65-79 years and ≥ 80 years), and T score (normal bone mineral density, osteopenia and osteoporosis).


Age, sex, BMI, and ALP and TG levels were independent risk factors for osteoporosis. For the 65-79- and ≥ 80-year-old groups, females presented lower T scores than males. Ca, P, ALB, ALP, TC, HDL and LDL levels were significantly different between men and women in the 65-79-year-old group. In addition, BMI and TG levels were significantly decreased in osteoporotic patients compared with patients with normal bone mass. TC levels declined in 65- to 79-year-old male and female osteoporosis patients. In the group of women aged ≥ 80 years, osteoporotic patients showed significantly increased ALP levels. Furthermore, we found positive correlations between BMI and TG levels in the male and female patient groups. However, we found no significant differences in ALB, Ca, P, HDL and LDL levels in osteoporotic patients compared to patients with normal bone mass.


Osteoporotic patients showed significantly decreased BMI and TG levels compared with those with normal bone mass. BMI showed positive correlations with TG levels in male and female patients. These results indicate correlations between BMI and bone mass and between lipid profiles and bone mass.

Keywords: Osteoporosis, Weight loss, Elderly patients, Body mass index, Lipid profiles

Core Tip: Older age, female gender, low body mass index (BMI), and low triglycerides (TG) were identified as overall independent factors for osteoporosis. Furthermore, low total cholesterol represented a gender-unspecific risk factor for osteoporosis in elderly patients aged 65-79 years, and high alkaline phosphatase represented a specific risk factor for osteoporosis in elderly male patients aged 80+ years. In addition, positive correlations were found between BMI and serum TG levels, suggesting an interaction between bone and fat metabolism that may have an impact on the development of osteoporosis and would provide a new strategy for the treatment of osteoporosis.