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ISSN : 1225-1577(Print)
ISSN : 2384-0900(Online)
The Korean Journal of Oral and Maxillofacial Pathology Vol.50 No.1 pp.9-18
DOI : https://doi.org/10.17779/KAOMP.2026.50.1.002

The Association Between Serum Lipoproteins and Osteoarthritis in the Elderly People

Hee Noh1, Byung-Gook Kim2*
1Department of Dental Hygiene, Gangdong University, Chungbuk, Korea
2Department of Oral Medicine, School of Dentistry, Chonnam National University, Gwangju, Korea
* Correspondence: Byung-Gook Kim, Department of Oral Medicine, Chonnam National University School of Dentistry, 77 Yongbong-ro, Buk-Gu, Gwangju 61186, Korea Tel: +82-62-530-5574 Email: bkkimom@jnu.ac.kr
December 24, 2025 January 23, 2026 January 23, 2026

Abstract


Dyslipidemia, whose prevalence increases with aging, is widely recognized as a contributor to chronic inflammation. However, the association between serum lipoprotein indices reflecting lipid metabolism and osteoarthritis, an age-related disease, has not been fully elucidated. This study aimed to evaluate the relationship between serum lipoprotein indices, remnant cholesterol, and osteoarthritis among older adults. This cross-sectional study used raw data from the 2018–2020 Korea National Health and Nutrition Examination Survey (KNHANES). Serum lipid parameters total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were analyzed. Remnant cholesterol was calculated as TC − (LDL-C + HDL-C). The association between serum lipid indices and osteoarthritis was assessed using multivariable regression analysis (logistic regression) adjusting for potential confounders. Among 296 participants aged ≥65 years, 89 (30.06%) reported having osteoarthritis. The osteoarthritis group had significantly higher remnant cholesterol (P < 0.05) and significantly lower HDL-C (P < 0.05) than the non-osteoarthritis group. There were no significant differences between groups in TC, LDL-C, or TG. In multivariable analyses, only remnant cholesterol showed a significant positive association with osteoarthritis risk (OR = 1.28, 95% CI: 1.08–1.54, P < 0.05). Although serum lipid abnormalities have been suggested as risk factors for osteoarthritis, the underlying epidemiologic mechanisms remain unclear. In this study, remnant cholesterol was significantly associated with osteoarthritis in older adults. Further studies are needed to clarify how metabolic factors such as hypercholesterolemia contribute to the development and progression of osteoarthritis. In addition, cholesterol reduction through lifestyle interventions—such as improving nutritional status and increasing physical activity—may represent a potential strategy for preventing and managing osteoarthritis in certain high-risk groups, and may help inform lifestyle guidance and identify novel targets for pharmacotherapy.


Serum lipoproteins , Remnant cholesterol , Osteoarthritis , Korea National Health and Nutrition Examination Survey , Cross-sectional study

노인의 혈청 지단백과 골관절염의 연관성

노희1, 김병국2*
1강동대학교 치위생학과
2전남대학교 치의학전문대학원 구강내과학교실

초록

    Ⅰ. INTRODUCTION

    Osteoarthritis (OA) is the most common degenerative disease worldwide, and there are no practical means of prevention and only limited treatment options. OA is the most prevalent type of arthritis that causes chronic disability and imposes a substantial socioeconomic burden, affecting many people—especially older adults.1

    Osteoarthritis has also been identified by the World Health Organization (WHO) as a major cause of disability in older adults and a source of social costs due to its high prevalence. As populations age and obesity increases, its prevalence is rising compared with previous decades. OA is a common and serious disease that primarily affects older individuals.1 It has been defined as a disease characterized by abnormal metabolism of joint tissues, manifesting as cartilage degradation, bone remodeling, joint inflammation, and loss of normal joint function.2 OA can affect one or more joints, most commonly the knee, finger joints, temporomandibular joint, hip, and spine. It is a major and growing cause of disability worldwide and is associated with comorbidities and increased mortality.1

    Cartilage destruction caused by an imbalance in the expression of anabolic factors in chondrocytes is a key feature of OA.2 Because effective disease-modifying drugs are currently unavailable, treatment approaches often ultimately require interventions including total joint arthroplasty. OA has long been regarded as a degenerative disease resulting from repetitive use and excessive mechanical loading on joints.3 However, recent studies suggest that OA is not attributable to weared down alone, but is closely related to metabolic disorders such as hypertension, hyperglycemia, and obesity.4,5 Thus, OA is a complex chronic disease that is frequently accompanied by multi-morbidity. Indeed, studies have shown that OA can be influenced by systemic factors such as adipokines, glucose, cholesterol, triglycerides (TG), and various metabolic derivatives.4-7

    Serum lipids have emerged as potential biomarkers for a wide range of diseases, including cardiovascular and cerebrovascular diseases,8,9 metabolic diseases,10 infectious diseases, 11 hematologic diseases,12 and cancer.13 Most previous studies on cholesterol metabolism have focused on low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). In addition, remnant cholesterol has recently been shown to predict the risk of atherosclerotic cardiovascular disease (CVD) as accurately as LDL-C or very-low-density lipoprotein (VLDL).14 Remnant cholesterol has been consistently associated with an increased likelihood of ischemic stroke in the general population,15,16 and —beyond the effect of LDL-C—has been found to be associated with hypertension in the overall adult population in the United States. This association persisted even after accounting for elevated triglyceride (TG) levels, suggesting the involvement of lipoproteins other than apolipoprotein B.17 Despite these findings, population-based studies examining the relationship between lipids and osteoarthritis in older adults remain limited. Therefore, the purpose of this study was to analyze raw data from the Korea National Health and Nutrition Examination Survey (KNHANES) VIII (2018– 2020) to investigate the association between lipoproteins, including cholesterol, and osteoarthritis.

    Ⅱ. RESEARCH SUBJECTS and METHODS

    Raw data from the Korea National Health and Nutrition Examination Survey (KNHANES) VIII (2018–2020) were analyzed. The data were obtained after submitting a data-use application to the Korea Disease Control and Prevention Agency (KDCA) and receiving Institutional Review Board approval (2018-01-03-2C-A). KNHANES is a nationally conducted, comprehensive survey that collects extensive information on the general population’s overall health and nutrition. KNHANES uses a carefully structured, stratified, multistage probability sampling design to ensure accurate representation. In addition, access to the KNHANES raw data —along with comprehensive documentation and protocols— is provided free of charge through the official website.

    The study population consisted of individuals aged 65 years or older (defined as older adults), using their examination data. To ensure the validity and reliability of the results, participants were excluded if they had missing data on total cholesterol (TC), LDL-C, or HDL-C; incomplete information such as responses related to arthritis; or missing physical health status information. These exclusions were applied to mitigate potential bias and improve the robustness of the analysis.

    Statistical analysis

    Using KNHANES data, multivariable logistic regression analysis was performed to examine the association between lipoproteins and osteoarthritis.

    Continuous variables are presented as mean ± standard deviation to describe their distributions. Differences in nutrient intake by osteoarthritis status, and comparisons of whether participants had other geriatric diseases concurrently, were assessed using the Mann–Whitney U test or the Kruskal –Wallis H test for statistical analysis.

    The association between osteoarthritis and lipoproteins in the older adult population was investigated through comprehensive multivariable logistic regression analyses. Because the analysis was restricted to individuals aged 65 years or older, covariate adjustment was consolidated accordingly.

    The relationship between osteoarthritis and lipoproteins was further evaluated using smooth curve fitting and threshold effect analyses. Statistical analyses were performed using IBM SPSS Statistics 29.0.2.0(IBM, NY, USA), with a predefined significance level of P < 0.05.

    Ⅲ. RESULTS

    After applying the exclusion criteria, participants with insufficient arthritis and lipoprotein data, unclear responses regarding osteoarthritis, and missing information on physical health status were excluded. Accordingly, the final study population consisted of 296 participants.

    Comparison of nutritional status according to osteoarthritis status

    The nutritional status of participants with and without osteoarthritis is shown in Table 1.

    Although total food intake was lower in the osteoarthritis group, the difference was not statistically significant. However, energy intake was significantly lower in the osteoarthritis group (1367.7 ± 530.5 kcal) than in the non-osteoarthritis group (1649.0 ± 616.8 kcal) (P < 0.05).

    Regarding essential nutrient intake, the osteoarthritis group had significantly lower intakes of protein, carbohydrates, and dietary fiber (P < 0.05), whereas sugar and polyunsaturated fatty acid intake were higher in the osteoarthritis group (P < 0.05). For electrolytes, phosphorus and zinc intake were significantly lower in the osteoarthritis group (P < 0.05), while calcium, potassium, magnesium, and iron intake did not differ significantly between the two groups.

    For vitamin intake, vitamin D, niacin, and folate intakes were lower in the osteoarthritis group (P < 0.05). No significant differences were observed for other vitamins between the two groups.

    Comparison of the relationship between osteoarthritis status and lipoproteins

    Table 2 compares the relationship between osteoarthritis and lipoproteins.

    Remnant cholesterol was higher in the osteoarthritis group (50.5 ± 22.8 mg/dL) than in the non-osteoarthritis group (32.2 ± 21.8 mg/dL) (P < 0.05). High-density lipoprotein cholesterol (HDL-C) was lower in the osteoarthritis group (41.5 ± 8.1 mg/dL) than in the non-osteoarthritis group (51.4 ± 10.4 mg/dL) (P < 0.05). Total cholesterol, low-density lipoprotein cholesterol (LDL-C), and triglycerides did not differ significantly between the two groups.

    Comparison of the relationship between geriatric diseases and lipoproteins

    Table 3 compares the associations between other geriatric diseases and lipoproteins in the population aged 65 years or older.

    The number of participants with dyslipidemia and diabetes mellitus was similar to the number of participants with osteoarthritis; however, more than half of the participants had hypertension. Participants with dyslipidemia, hypertension, and diabetes mellitus had significantly higher levels of remnant cholesterol, total cholesterol, and LDL-C. Although the etiologic relationship between cholesterol and dyslipidemia or hypertension is well established, differences in lipoproteins were also observed in those with diabetes mellitus.

    Association between lipoproteins and osteoarthritis

    A positive linear relationship between osteoarthritis and lipoproteins was identified. Table 4 presents the results of the multivariable logistic regression analysis.

    Only remnant cholesterol showed a positive association, with an odds ratio (OR) of 1.28 (95% CI: 1.08–1.54; P < 0.05) (Figure 1). In particular, a stable association was observed in the remnant cholesterol range of 40 to 60 mg/dL. No significant associations were found for other lipoproteins. These results indicate that the odds of osteoarthritis increased by about 28% for each increase in remnant cholesterol.

    Ⅳ. DISCUSSION

    With population aging and the resulting increase in the older adult population, the category of “geriatric diseases” has been defined. Diseases in older adults may present with atypical symptoms compared with those in younger populations. In addition, older patients often have multiple physical comorbidities simultaneously and therefore have a high likelihood of taking various medications. Moreover, reduced activity with advancing age increases the prevalence of hypertension, dyslipidemia, hypercholesterolemia, and conditions known as metabolic syndrome, which are well-recognized risk factors for diabetes mellitus, cardiovascular disease, and atherosclerosis. Recently, it has been reported that most of these conditions may be associated with an increased risk of osteoarthritis (OA).1–3

    Lipids are large molecules with complex structures that play important roles in maintaining cellular function.18 There are four major classes of lipids in the human body: triglycerides (TG), fatty acids (FAs), cholesterol, and phospholipids. It has been shown that adequate nutrients to maintain the structure and function of mature articular cartilage are provided by synovial fluid rather than subchondral bone.19 The diffusion of solute molecules within synovial fluid is strongly influenced by compressive and cyclic loading of the joint.20 To increase solubility, lipids generally exist as lipoproteins in the blood or are bound to carrier plasma proteins. When bound to large molecules, the transport of lipids into cartilage becomes limited, which may pose a problem. In addition, remnant cholesterol (RC), which was included in this study, is a novel marker representing cholesterol in triglyceride-rich lipoproteins and is associated with a variety of conditions encompassing cardiovascular and metabolic disorders.21 Serum lipids have emerged as potential biomarkers for diverse diseases, including cardiovascular and cerebrovascular diseases,8,9 metabolic diseases,10 infectious diseases,11 hematologic diseases, 12 and cancer.13 Most previous studies on cholesterol metabolism have focused on low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). remnant cholesterol has recently been shown to predict the risk of atherosclerotic cardiovascular disease (CVD) as accurately as LDL-C or very-low-density lipoprotein (VLDL).14

    Regarding covariates, some of rheumatoid arthritis cases were associated with smoking or low alcohol consumption.22 Associations between sex, alcohol consumption, and rheumatoid arthritis or osteoarthritis were also observed in a cross-sectional analysis with a median age of 66 years, whereas no association was found with smoking or social activity.23 Furthermore, prior alcohol intake and smoking were associated with increased prevalence across various types of arthritis.24 Although social and physical activity is recognized as an effective approach for arthritis management, 25 several studies have not confirmed an association between social/physical activity and arthritis.23,24 Such inconsistencies across findings have been reported. In the present study, the analysis was restricted to individuals aged 65 years or older, and due to the final sample size, covariates such as social characteristics and lifestyle patterns were not considered.

    In this study, osteoarthritis in older adults was characterized by higher remnant cholesterol and lower HDL-C levels. However, in terms of the association between osteoarthritis and lipoproteins, only higher remnant cholesterol showed a positive association with osteoarthritis. Epidemiologic studies have yielded inconsistent conclusions regarding the association between osteoarthritis and elevated serum cholesterol levels. Some studies reported a positive association between hypercholesterolemia and osteoarthritis, while others found a negative correlation.26 Hypercholesterolemia has been associated with unilateral and bilateral knee osteoarthritis independently of obesity,27 supporting evidence that serum cholesterol may play an independent role as a systemic risk factor for osteoarthritis.28 In contrast, metabolic factors including triglycerides, cholesterol, and blood glucose levels were not correlated with osteoarthritis in one study.26 Serum HDL levels were significantly lower in patients with osteoarthritis. A positive association has been reported between high TG levels and low HDL levels and the incidence of osteoarthritis.29 There are also studies on the association between rheumatoid arthritis and cholesterol, showing that HDL-C levels were slightly higher than those in osteoarthritis patients, while mean TC, LDL-C, and TG levels were lower.30 In addition, a study using genome-wide association study data suggested complex and contradictory relationships between lipid factors and rheumatoid arthritis, 31 but did not establish causality between rheumatoid arthritis and changes in lipid factors.

    Furthermore, as shown in the additional comparisons of lipoproteins among participants with dyslipidemia, hypertension, and diabetes mellitus, it appears likely that the same individuals may have overlapping diseases. This may indicate the potential impact of abnormal lipoprotein levels on osteoarthritis progression,22,32-37 and suggests that elevated cholesterol can worsen cartilage degradation and osteoarthritis progression, with the relation to blood glucose level also warranting consideration.

    The heterogeneity of previous findings regarding associations between osteoarthritis and lipoproteins35,38 may be attributable to the widespread use of cholesterol-lowering medications among individuals with hyperlipidemia in the studied populations. However, cholesterol-lowering drugs, such as statins, do not yet appear to have been extensively evaluated clinically for the treatment of osteoarthritis. To more accurately assess the relationship between serum lipoprotein levels and osteoarthritis occurrence, future studies may need to exclude participants receiving cholesterol-lowering medications.

    Understanding the role of cholesterol in osteoarthritis could clearly influence the clinician’s role in comprehensive health management. If a clear association between hypercholesterolemia and osteoarthritis is identified, clinicians may recommend lipid testing when evaluating patients, particularly in cases without an obvious external cause. If elevated cholesterol is detected in blood tests, guidance would be needed not only on medications to achieve safe cholesterol levels but also on lifestyle modifications.

    Strengths and limitations

    The additional evidence provided by this study regarding the association between serum lipoproteins and osteoarthritis strengthens the existing literature. Use of the KNHANES database facilitated investigation of a practical and representative cohort, enhancing the generalizability of the findings.

    Nevertheless, it is essential to acknowledge limitations inherent to this study. First, while longitudinal studies are necessary to clarify the temporal aspects of this association, the present study was cross-sectional, limiting the ability to establish causality between serum lipoproteins and osteoarthritis. Second, osteoarthritis diagnosis was obtained from KNHANES questionnaire data, and more detailed classification by arthritis type was lacking. Third, data on medications that could affect serum lipoproteins and osteoarthritis were not fully included, and adjustment for covariates was not performed.

    Ⅴ. CONCLUSION

    Although abnormal serum lipoprotein profiles have recently been proposed as a risk factor for osteoarthritis, the molecular mechanisms underlying this association remain unclear. It is important to understand how metabolic factors, such as elevated cholesterol levels, contribute to the development of osteoarthritis, because many risk factors can be managed through simple lifestyle changes without medical treatment. As suggested by this study, reducing cholesterol levels through lifestyle improvements such as adequate supplementation of nutrients that are insufficiently consumed by older adults and promotion of physical activity may represent one approach to preventing the onset and progression of osteoarthritis in specific high-risk groups. Further research in this area is needed, and efforts should be made to provide lifestyle guidance and identify new therapeutic targets, including pharmacologic treatments, to reduce osteoarthritis risk in older adults.

    Figure

    KAOMP-50-1-9_F1.jpg

    Relationship between Remnant Cholesterol and Osteoarthritis

    Table

    The nutritional status of participants with and without osteoarthritis

    Comparison of the relationship between osteoarthritis status and lipoproteins

    Unit of value is mg/dL
    The values are mean +/- standard deviation
    Probability ; P<0.05

    Comparison of the relationship between geriatric diseases and lipoproteins

    Unit of value is mg/dL
    The values are mean +/- standard deviation
    Probability ; P<0.05

    Distribution of dyslipidemia components in subjects with and without osteoarthritis and results of logistic regression analysis * OR and 95% CI were estimated using logistic regression analysis. CI: confidence interval; OR: odds ratio

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