Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and osteoporotic fracture

Background The non-high-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (NHHR) has emerged as a valuable lipid marker associated with various cardiometabolic diseases. Although evidence links lipid metabolism to skeletal health, the relationship between NHHR and osteoporotic fractures remains unexplored. This study aims to assess the association between NHHR and the risk of osteoporotic fractures. Method This retrospective cross-sectional study included 580 patients from the Department of Endocrinology at Gansu Provincial People's Hospital between January 2020 and December 2024. The association between NHHR and osteoporotic fracture was assessed using multivariate logistic regression with covariate adjustment. RCS analysis explored non-linear relationships, and comprehensive subgroup analyses validated the findings' consistency. Results In fully adjusted multivariate logistic regression models, NHHR demonstrated a significant inverse association with osteoporotic fracture (OR = 0.55, 95% CI: 0.45–0.66, p < 0.001), with each one-unit increment corresponding to a 45% reduction in fracture odds. Categorical analysis by NHHR quartiles confirmed a dose-response relationship, with participants in the highest quartile exhibiting 80% lower odds of fracture compared to the reference lowest quartile (OR = 0.20, 95% CI: 0.11–0.36, p < 0.001). Restricted cubic spline regression revealed a significant non-linear relationship ( p for non-linearity < 0.001) with an inflection point identified at NHHR = 3.29. In stratified analyses, the inverse association between NHHR and osteoporotic fracture persisted across all demographic subgroups. Conclusions Our study identified a significant non-linear association between NHHR and osteoporotic fracture risk. Due to its retrospective nature, further prospective investigations are needed to confirm these [r]results.