Navigating the Intersection of Osteoporosis Treatment and Hyperlipidemia

A large-scale cohort study from Taiwan is shedding new light on the complex relationship between osteoporosis and hyperlipidemia—two seemingly distinct conditions that may share biological underpinnings and clinical trajectories. Researchers report that not only are patients with osteoporosis at significantly higher risk for developing hyperlipidemia, but that anti-osteoporotic treatments (AOTs) appear to offer a protective benefit, potentially influencing broader cardiovascular outcomes.

Drawing from Taiwan’s Longitudinal Generation Tracking Database, investigators tracked over 135,000 adults for up to two decades, comparing osteoporosis patients with matched controls. After adjusting for key factors including age, sex, and comorbidities, the incidence rate of hyperlipidemia among individuals with osteoporosis was 36.7 per 1,000 person-years, compared to 28.4 in the control group—a 59% increase in relative risk (adjusted HR 1.59; 95% CI, 1.56–1.63).

The association persisted across all subgroups, including sex, age brackets, and comorbidity profiles. Notably, women with osteoporosis had a higher adjusted risk of hyperlipidemia than men (HR 1.31 vs. 1.16), and individuals without existing comorbidities paradoxically demonstrated a steeper risk increase than those with one or more chronic conditions.

But perhaps the study’s most intriguing finding lies in the mitigating effect of AOTs. Among patients with osteoporosis, those who received medications such as bisphosphonates, denosumab, selective estrogen receptor modulators (SERMs), calcitonin, teriparatide, and vitamin supplements experienced a markedly reduced risk of hyperlipidemia. Teriparatide, for instance, was associated with a 69% lower risk compared to untreated peers (adjusted HR 0.31), while denosumab and bisphosphonates were linked to reductions of 56% and 30%, respectively.

The findings also reinforce the idea that osteoporosis and hyperlipidemia are not entirely siloed disorders. Both are associated with aging, estrogen deficiency, and metabolic dysregulation. Postmenopausal women, who are already at increased risk for both conditions due to declining estrogen levels, may represent a particularly vulnerable subgroup. Estrogen’s dual role in promoting bone formation and regulating lipid metabolism helps explain this intersection.

The study offers compelling evidence that clinicians treating osteoporosis should also be mindful of cardiovascular risk—and vice versa. The interplay between skeletal and metabolic health is becoming increasingly relevant as populations age and multimorbidity becomes the norm.