Baseline characteristics of the subjects.

BackgroundSerum lipid levels have been shown to influence bone mineral density. Additionally, a limited number of studies have suggested that remnant cholesterol (RC) may be linked to the risk of osteoporosis. However, the relationship between RC and fracture risk remains unclear. This study aimed to explore the association between RC levels and the risk of vertebral fractures in a longitudinal cohort.MethodsA total of 1995 participants aged 50 years or older who underwent chest computed tomography (CT) scans for lung cancer screening between July 2016 and December 2019 were included in this study. Follow-up continued until June 2023. The concentration of RC was calculated via the following formula: total cholesterol minus the sum of high-density lipoprotein cholesterol and low-density lipoprotein cholesterol. The RC-to-cholesterol ratio was also determined. The participants were divided into low and high groups for RC, and the RC-to-cholesterol ratio was based on the median values. Vertebral fractures were assessed via the Genant semiquantitative classification system on CT-reconstructed sagittal images.ResultsDuring a median follow-up period of 60 months, 95 new vertebral fractures were recorded. The incidence of fractures was significantly greater among participants with low RC levels than among those with high RC levels (6.4% vs. 3.1%, P ConclusionHigher levels of remnant cholesterol and a higher RC-to-cholesterol ratio were associated with a reduced risk of vertebral fractures, particularly in women.