Preventing fragility fractures in patients with hypercholesterolemia:
the importance of REMS technolog
Chiara Stomaci, Fabiola Rosa Contaldo, Marco Di Paola, Roberto Franchini, Fiorella Anna Lombardi, Giusy Peluso, Paola Pisani, Francesco Conversano, Sergio Casciaro
Purpose: Hypercholesterolemia (HC) is associated with altered bone metabolism, potentially increasing osteoporosis and fracture risk. This study evaluates bone quality in HC patients using the REMS-derived Fragility Score (FS), and compares it with that of an age- and BMI-matched healthy population.
Methods: A retrospective study was conducted in 184 Caucasian patients (105 HC patients, 79 healthy controls) from “A. Galateo” Hospital (Lecce, Italy). REMS ultrasound scans were performed at the lumbar spine and proximal femur using the EchoStation device to assess T-score and FS. The Shapiro-Wilk test was used to assess normality of distribution, and the Mann-Whitney test to compare the means of the two groups. To evaluate the diagnostic performance of FS in identifying patients with deteriorated bone quality, a receiver operating characteristic curve analysis was performed. p < 0.05 was always considered statistically significant.
Results: HC patients showed significantly higher FS and significantly lower T-scores than controls. Median lumbar spine FS and T-score were 73.12 [65.7 – 77.4] and -2.30 [-2.75 – (-1.70)] in HC patients vs. 25.01 [19.7 – 27.1] and -1.60 [-2.2 – (-1.1)] in controls (p < 0.0001). Similar differences were observed at the proximal femur (p < 0.0001). FS showed good discriminative ability for bone quality, with area under the curve values of 0.74 (lumbar, p < 0.001) and 0.81 (femur, p < 0.001).
Conclusions: HC negatively impacts bone quality, increasing the probability of fragility fracture risk. REMS-derived FS effectively distinguishes compromised HC patients, supporting its use in bone health monitoring and early intervention.
KEY WORDS: Hypercholesterolemia, bone quality, REMS, fragility score.
