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. 2025 Dec 4:18:17045-17056.
doi: 10.2147/JIR.S534180. eCollection 2025.

Association of NLR and Ferritin in Osteoporotic Fractures Among Chinese Older Patients

Hao-Tian Jiao #  1   2 , Zhou-Hang Liu #  2   3 , Peng Zhou #  1   2 , Shuai Yuan  2   3 , Ke Lu  1   2 , Chong Li  1   2
Affiliations

Association of NLR and Ferritin in Osteoporotic Fractures Among Chinese Older Patients

Hao-Tian Jiao et al. J Inflamm Res. .

Abstract

Background: Research on the connection between serum ferritin levels and the neutrophil-to-lymphocyte ratio (NLR) in individuals with osteoporotic fractures (OPF) are currently limited. This study aims to investigate the relationship between the NLR and serum ferritin levels, with the goal of offering a more convenience method for assessing iron stores and inflammatory response in clinical settings.

Methods: A retrospective cross-sectional analyzed 4782 patients with OPF. Initial measurements included serum ferritin and NLR. The analysis accounted for various confounders. Furthermore, techniques such as multivariable linear regression, smooth curve fitting, and threshold analysis techniques were utilized.

Results: A strong association was observed between serum ferritin levels and the NLR in patients with OPF (β = 6.36, 95% CI, 2.02, 10.65, P-value < 0.01). The recognized threshold was 5.31. When levels dropped below this point (< 5.31), there was a notable rise in serum ferritin (β= 32.08; 95% CI, 12.97, 51.20, P-value < 0.01). This study discovered a threshold effect between serum ferritin and NLR.

Discussion: Recognizing this threshold effect holds substantial clinical importance, as it could provide a novel approach for assessing inflammation levels and iron reserves in patients with OPF. Higher or lower NLR may be relevant for identifying iron status. Clinicians may assess the iron status of patients with OPF by monitoring NLR, which may serve as an indicator of their iron reserves. This information can facilitate the formulation of targeted strategies for diagnosis and treatment. Nevertheless, further detailed studies are needed to confirm the current results.

Conclusion: The study reveals a threshold effect between serum ferritin and NLR in patients with OPF, showing a positive correlation, particularly when NLR is below 5.31. This discovery reveals that NLR may serve as a biomarker for rapidly evaluating iron reserves in patients with OPF. Therefore, clinicians may incorporate NLR as a potential biomarker for quick iron evaluation to determine the next step of comorbidity screening and treatment plan.

Keywords: neutrophil-to-lymphocyte ratio; osteoporosis; osteoporotic fractures; serum ferritin.

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Conflict of interest statement

The authors declare that they have no competing interests in this work.

Figures

Figure 1
Figure 1
Research workflow diagram. This flowchart illustrates the selection process for patients.
Figure 2
Figure 2
The association between serum ferritin levels and NLR. Adjusted smoothed curves illustrated this relationship in hospitalized patients with OPF. A generalized additive model indicated a thresholded non-linear association between serum ferritin and NLR. The upper and lower curves indicate the 95% confidence interval, while the middle curve depicts the relationship between serum ferritin and NLR. The models were refined to account for different covariates. In Model 3, the red curve displayed an inflection point (K) at 5.31. NLR and Serum Ferritin: Smooth curve (A) and Scatter plot (B).
See this image and copyright information in PMC

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