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. 2025 Dec 26;27(1):69.
doi: 10.1186/s12891-025-09460-8.

A threshold effect of Apolipoprotein A1 levels on systemic inflammatory response index in individuals with osteoporotic fractures: a cross-sectional study

Guo-Ji Lin  1 , Shao-Han Guo  1 , Jia-Qi Liang  1 , Yue-Qin Guo  2 , Chong Li  1 , Ke Lu  3
Affiliations

A threshold effect of Apolipoprotein A1 levels on systemic inflammatory response index in individuals with osteoporotic fractures: a cross-sectional study

Guo-Ji Lin et al. BMC Musculoskelet Disord. .

Abstract

Background: Chronic inflammation and lipid metabolism are closely associated with osteoporotic fractures. Previous studies have reported associations between Apolipoprotein A1 (ApoA1) and inflammatory markers in specific inflammatory diseases. Nevertheless, the association between ApoA1 and the Systemic Inflammatory Response Index (SIRI) has been scarcely investigated in populations with osteoporotic fractures. We therefore conducted this cross-sectional study to examine this association.

Methods: In this cross-sectional study, 2067 patients with osteoporotic fractures (OPF) needing surgical intervention at Kunshan Hospital affiliated with Jiangsu University from January 2017 to July 2022 were enrolled. The relationship between serum ApoA1 concentrations and SIRI was evaluated and described using linear regression models and smooth curve fitting. A two-piecewise linear regression model was employed to identify the inflection point. Additionally, stratified and univariate analyses were conducted.

Results: After accounting for potential confounders, serum ApoA1 concentrations were discovered to have an inverse association with SIRI (β = -0.822, 95% CI (-1.491, -0.153), P = 0.016). Moreover, the smoothed plot revealed a non-linear relationship between serum ApoA1 concentrations and SIRI, with the inflection point observed at ApoA1 levels of 1.25 g/L. The magnitude of effect and 95% CI on either side of the inflection point were -2.258 (-3.541, -0.974) and 0.512 (-0.706, 1.729), respectively. In addition, further subgroup analyses reinforced the consistency of the association between ApoA1 concentrations and SIRI.

Conclusions: Our study revealed a threshold effect between serum ApoA1 levels and SIRI in patients with OPF, demonstrating a negative correlation between ApoA1 and SIRI within a specific range. However, further research is warranted to expand and validate these findings.

Keywords: Apolipoprotein A1; Osteoporotic fractures; Systemic inflammation response index.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This is a retrospective observational study. We received ethical approval from the Affiliated Kunshan Hospital of Jiangsu University (approval No. 2021-06-015-K01), and was compliant with the Declaration of Helsinki. As this was an observational study and data were gathered anonymously, written informed consent was not required for these analyses. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
The adjusted smoothed curves illustrate the association between serum ApoA1 levels and the SIRI. A generalized additive model identified a threshold non-linear association between serum ApoA1 levels and SIRI in patients with OPF. The upper and lower blue curves denote the boundaries of the 95% confidence interval, whereas the central red curve elucidates the association between ApoA1 levels and SIRI. The model has been adjusted for variables including gender, age, BMI, primary diagnosis, ASA, CCI, hypertension, diabetes, smoking, drinking, platelet count, ALT, and AST. In Model 4, the red curve indicates an inflection point (K) at 1.25. ApoA1 Apolipoprotein A1, SIRI systemic inflammation response index, OPF osteoporotic fractures, CI confidence interval, ALT alanine aminotransferase, AST aspartate aminotransferase, BMI body mass index, CCI Charlson comorbidity index, ASA American Society of Anesthesiologists
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References

    1. Bigdon SF, Saldarriaga Y, Oswald KAC, Müller M, Deml MC, Benneker LM, Albers TME. Epidemiologic analysis of 8000 acute vertebral fractures: evolution of treatment and complications at 10-year follow-up. J Orthop Surg Res. 2022;17(1):270. - DOI - PMC - PubMed
    1. Zhang H, Hu Y, Chen X, Wang S, Cao L, Dong S, Shi Z, Chen Y, Xiong L, Zhang Y, et al. Expert consensus on the bone repair strategy for osteoporotic fractures in China. Front Endocrinol (Lausanne). 2022;13:989648. - DOI - PMC - PubMed
    1. Wändell P, Li X, Carlsson AC, Sundquist J, Sundquist K. Osteoporotic fractures among foreign-born individuals: a National Swedish study. Osteoporos Int. 2021;32(2):343–52. - DOI - PMC - PubMed
    1. Wang J, Shu B, Tang DZ, Li CG, Xie XW, Jiang LJ, Jiang XB, Chen BL, Lin XC, Wei X, et al. The prevalence of osteoporosis in China, a community based cohort study of osteoporosis. Front Public Health. 2023;11:1084005. - DOI - PMC - PubMed
    1. Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet. 2019;393(10169):364–76. - DOI - PubMed

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