Hypercholesterolaemia increases the risk of high‑turnover osteoporosis in men

Zhou,Yanman; Deng,Tuo; Zhang,Haiqing; Guan,Qingbo; Zhao,Hongqiang; Yu,Chunxiao; Shao,Shanshan; Zhao,Meng; Xu,Jin

doi:10.3892/mmr.2019.10131

Hypercholesterolaemia increases the risk of high‑turnover osteoporosis in men

Authors:
- Yanman Zhou
- Tuo Deng
- Haiqing Zhang
- Qingbo Guan
- Hongqiang Zhao
- Chunxiao Yu
- Shanshan Shao
- Meng Zhao
- Jin Xu
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Affiliations: Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China, Department of Internal Medicine, Laiwu People's Hospital, Laiwu, Shandong 271100, P.R. China
Published online on: April 4, 2019 https://doi.org/10.3892/mmr.2019.10131
Pages: 4603-4612
Copyright: © Zhou et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

As the incidence of osteoporosis (OP) and hypercholesterolaemia in men has increased, male OP has drawn more attention from clinicians worldwide. The present study sought to investigate the effects of cholesterol on male bone. Between July 2015 and October 2015, 216 men (aged ≥18 years) were recruited for this cross‑sectional study. To test our clinical hypothesis, we designed two male animal models: Exogenous hypercholesterolaemia induced by a high‑cholesterol diet (HCD) and endogenous hypercholesterolaemia induced by apolipoprotein E (ApoE) knockout. Finally, the direct effects of cholesterol on osteoblasts were observed in cell experiments. In our clinical studies, men with hypercholesterolaemia displayed a lower bone mineral density (BMD) and increased beta collagen cross‑linking (beta‑CTX) and type I anterior collagen amino terminal peptide (PINP) levels compared to those of the control subjects. Serum cholesterol levels were a significant independent predictor of BMD, beta‑CTX and PINP and were negatively correlated with BMD and positively correlated with beta‑CTX and PINP levels. Our animal experimental results validated our clinical results, as they also indicated that hypercholesterolaemia damages bone microstructure and reduces bone strength. Cholesterol directly increased osteoblast functional gene expression in vitro. Hypercholesterolaemia increases the risk of high‑turnover osteoporosis in men at least in part by excessively promoting the activity of the remodelling pathway. In addition, hypercholesterolaemia damages the bone microstructure, resulting in osteopenia or OP and reduced bone strength, leading to a higher risk of fracture in men. We emphasize the importance of preventing and treating hypercholesterolaemia as well as monitoring bone metabolic markers and BMD in men with hypercholesterolemia for the effective prevention of bone loss and subsequent fracture. In addition, our findings provide a theoretical basis for the development of treatments for high cholesterol‑induced osteoporosis in men.

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