Inverse relationship between neutrophil lymphocyte ratio (NLR) and bone mineral density (BMD) in elderly people

Abstract Osteoporosis is, an age related disorder, influencing elderly people worldwide. The latest data suggests that inflammation plays a critical role in bone remodeling and in pathogenesis of osteoporosis. NLR is a simple, non-invasive and cost-effective marker of inflammation in various malignancies and inflammatory diseases. The objective of the present study was to compare NLR levels in osteopenic, osteoporotic and control subjects and to assess the correlation between NLR levels and BMD. A total of 1635 patients aged 65 years or more were included in this cross-sectional study. BMD was measured by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine and femur. Complete blood count (CBC), biomarkers of inflammation (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)), glucose/lipid metabolism and established risk factors were determined. In osteoporosis group, NLR levels were found to be elevated as compared to osteopenic and control group (2.54 ± 1.45, 2.37 ± 1.00 and 2.18 ± 0.85, respectively). At multivariate analysis NLR emerged as independent predictor of osteoporosis (OR = 1.122; 95% = 1.020–1.235, p  = 0.018) and there was a significant negative correlation between lumbar spine (L2–L4), femoral neck scores and NLR ( r  = 0.348, p r  = 0.264, p  = 0.004, respectively). Elderly people with osteoporosis have elevated NLR levels, suggesting that inflammation may play an important role in bone remodeling.