Hyperlipidemia, Obesity, and Diabetes, and Risk of Ossification of the Posterior Longitudinal Ligament

Several risk factors of ossification of the posterior longitudinal ligament (OPLL) have been established, including diabetes and obesity. However, the relationship between hyperlipidemia (HLD) and OPLL is incompletely understood. PearlDiver was queried to identify adults with (+) and without (–) HLD, diabetes, and obesity. Comparative analyses were performed on demographics, comorbidities, and OPLL rates before and after matching for age, sex, and comorbidities. Stepwise logistic regression modeling assessing the relationship between HLD and OPLL with the addition of predictor variables was also performed. In total, 31,677 cervical OPLL patients, as well as 170,467 HLD+ and 118,665 HLD–, 168,985 Diabetes+ and 137,966 Diabetes–, and 150,363 Obesity+ and 142,553 Obesity– patients, were examined. Mean age ranged from 43.44-59.46 years, 54.94-63.12% were females, and mean CCI ranged from 0.06-1.53, all higher in those with the comorbidity. Before matching, OPLL rates were higher in those with HLD (HLD+=0.05% vs HLD–=0.03%, p=0.005), diabetes (Diabetes+=0.06% vs Diabetes–=0.02%, p<0.001), and obesity (Obesity+=0.05% vs Obesity–=0.02%, p=0.001). However, after matching by age, sex, and CCI, the associations between the studied comorbidities and OPLL were attenuated (all p>0.05). Stepwise regression modeling revealed an association between HLD and cervical OPLL that was most impacted by the addition of age (OR=1.95, R2=0.029 to OR=1.38, R2=0.075) and obesity (OR=1.21, R2=0.086 to OR=1.07, R2=0.111) into the model. Cervical OPLL rates were higher in patients with HLD even after accounting for demographics and comorbidities. HLD may be an independent risk factor for OPLL development.