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Lipoprotein(a) plasma levels, bone mineral density and risk of hip fracture: a post hoc analysis of the Women's Health Initiative, USA
Open Access Articles
  • Bernhard Haring, University of Würzburg
  • Carolyn J. Crandall, University of California, Los Angeles
  • Laura Carbone, Augusta University
  • Simin Liu, Brown University
  • Wenjun Li, University of Massachusetts Medical School
  • Karen C. Johnson, University of Tennessee
  • Jean Wactawski-Wende, SUNY University at Buffalo
  • Aladdin H. Shadyab, University of California - San Diego
  • Margery L. Gass, North American Menopause Society
  • Victor Kamensky, Albert Einstein College of Medicine
  • Jane A. Cauley, University of Pittsburgh
  • Sylvia Wassertheil-Smoller, Albert Einstein College of Medicine
UMMS Affiliation
Department of Medicine, Division of Clinical Informatics; UMass Worcester Prevention Research Center
Publication Date
Document Type

OBJECTIVES: Elevated Lipoprotein(a) (Lp[a]) is a well-known risk factor for cardiovascular disease. However, its roles in bone metabolism and fracture risk are unclear. We therefore investigated whether plasma Lp(a) levels were associated with bone mineral density (BMD) and incident hip fractures in a large cohort of postmenopausal women.

DESIGN: Post hoc analysis of data from the Women's Health Initiative (WHI), USA.

SETTING: 40 clinical centres in the USA.

PARTICIPANTS: The current analytical cohort consisted of 9698 white, postmenopausal women enrolled in the WHI, a national prospective study investigating determinants of chronic diseases including heart disease, breast and colorectal cancers and osteoporotic fractures among postmenopausal women. Recruitment for WHI took place from 1 October 1993 to 31 December 1998.

EXPOSURES: Plasma Lp(a) levels were measured at baseline.

OUTCOME MEASURES: Incident hip fractures were ascertained annually and confirmed by medical records with follow-up through 29 August 2014. BMD at the femoral neck was measured by dual X-ray absorptiometry in a subset of participants at baseline.

STATISTICAL ANALYSES: Cox proportional hazards and logistic regression models were used to evaluate associations of quartiles of plasma Lp(a) levels with hip fracture events and hip BMD T-score, respectively.

RESULTS: During a mean follow-up of 13.8 years, 454 incident cases of hip fracture were observed. In analyses adjusting for confounding variables including age, body mass index, history of hysterectomy, smoking, physical activity, diabetes mellitus, general health status, cardiovascular disease, use of menopausal hormone therapy, use of bisphosphonates, calcitonin or selective-oestrogen receptor modulators, baseline dietary and supplemental calcium and vitamin D intake and history of fracture, no significant association of plasma Lp(a) levels with low hip BMD T-score or hip fracture risk was detected.

CONCLUSIONS: These findings suggest that plasma Lp(a) levels are not related to hip BMD T-score or hip fracture events in postmenopausal women.


  • bone mineral density,
  • fractures,
  • lipoprotein (a),
  • postmenopausal women
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Copyright © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:
DOI of Published Version

BMJ Open. 2019 Apr 24;9(4):e027257. doi: 10.1136/bmjopen-2018-027257. Link to article on publisher's site

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Creative Commons Attribution-Noncommercial 4.0
Citation Information
Bernhard Haring, Carolyn J. Crandall, Laura Carbone, Simin Liu, et al.. "Lipoprotein(a) plasma levels, bone mineral density and risk of hip fracture: a post hoc analysis of the Women's Health Initiative, USA" Vol. 9 Iss. 4 (2019) ISSN: 2044-6055 (Linking)
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