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Nutrición Hospitalaria 05938 / http://dx.doi.org/10.20960/nh.05938
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Associations of serum vitamins, carotenoids, and retinyl esters with risk of hip and spine fractures

Yifan Lu, Zhuo Yang, Jianhui Duan, Wangyang Li, Wei Tan, Ying Li, Qunfei Xiao, Zhi Tang, Hui Xiong

Prepublicado: 2025-09-18

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Background: most existing studies have explored the association between the intake of vitamins, carotenoids, and retinyl esters and fracture risk based on dietary questionnaires. However, these studies often involve small sample sizes and show considerable heterogeneity in results both across and within populations. To date, there is a lack of research systematically evaluating the relationships between serum concentrations of vitamins, carotenoids, and retinyl esters and the risks of hip and vertebral fractures. This study aimed to investigate these associations. Methods: using data from the National Health and Nutrition Examination Survey (NHANES), we employed multivariable logistic regression models to assess the associations between serum levels of vitamins, carotenoids, and retinyl esters and the risk of hip and vertebral fractures. Nonlinear relationships were explored using smooth curve fitting and two-piecewise linear regression models. Subgroup analyses were conducted to identify potential effect modifiers. The predictive performance of significant biomarkers was evaluated using receiver operating characteristic (ROC) curves. Mediation analysis was further performed to explore the mediating role of bone mineral density (BMD) in these associations. Results: serum levels of α-carotene, β-cryptoxanthin, vitamin E, and trans-lycopene were inversely associated with the risk of hip fractures. α-Carotene and lutein-zeaxanthin showed marginal associations with vertebral fracture risk. Nonlinear analyses suggested protective effects of α-carotene and β-cryptoxanthin at lower concentration ranges. ROC curve analysis indicated that serum α-carotene could serve as a potential independent predictor of hip fracture risk. Mediation analysis revealed that BMD at the intertrochanter and trochanter regions partially mediated the associations between α-carotene, β-cryptoxanthin, and hip fracture risk. Conclusion: this study is the first to confirm, based on serum biomarkers, the inverse associations of α-carotene and β-cryptoxanthin with fracture risk, and to report the relationship between trans-lycopene and hip fracture risk. α-Carotene and β-cryptoxanthin demonstrated protective effects at lower serum levels, partially mediated through BMD, and serum α-carotene may serve as a potential independent biomarker for predicting hip fracture risk.

Palabras Clave: Serum α-carotene. Serum β-cryptoxanthin. Trans-lycopene. Hip fracture risk. Mediation analysis.



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