Inverse relationship between neutrophil lymphocyte ratio (NLR) and bone mineral density (BMD) in elderly people Zeynel Abidin O ¨ ztu ¨ rk a, *, Yusuf Yesil b , Mehmet Emin Kuyumcu b , Muhammed Bilici c , Nazire O ¨ ztu ¨ rk d , Nesibe Karahan Yes ¸ il e , Mesut O ¨ zkaya f , Bu ¨ nyamin Kısacık g , Yalc ¸ın Kepekc ¸i a , Servet Arıog ˘ul b a Gaziantep University, Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, 27100 Sahinbey, Gaziantep, Turkey b Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, 06100 Sihhiye, Ankara, Turkey c Gaziantep University Faculty of Medicine, Department of Internal Medicine, 27100 Sahinbey, Gaziantep, Turkey d Gaziantep Hatem Hospital, Department of Obstetrics and Gynecology, 27400, S ¸ahinbey, Gaziantep, Turkey e Ankara Numune Education and Research Hospital, Department of Internal Medicine, Division of Rheumatology, 06100, Sıhhiye, Ankara, Turkey f Gaziantep University, Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology, 27100 Sahinbey, Gaziantep, Turkey g Gaziantep University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, 27100 Sahinbey, Gaziantep, Turkey 1. Introduction Osteoporosis is a major healthcare burden, characterized by destruction in bone mass and micro architecture with increasing fragility and causing the bone to fracture (Duque & Troen, 2008). Osteoporosis related fractures decrease life quality and cause disability in elderly population. Its etiology is referred to various factors including genetics, nutritional, endocrinologic, mechanic and metabolic (Yun & Lee, 2004). The link between osteoblasts, osteoclasts and pro-inflammatory cytokines suggests that inflam- mation also contributes to pathogenesis in osteoporosis (Arron & Choi, 2000; Mundy, 2007; Yun & Lee, 2004). Some in vitro and rodent studies have found a remarkable correlation between inflammatory markers such as Interleukin-1 (IL-1), Interleukin-6 (IL-6), CRP, tumor necrosis factor-alpha (TNF-a) levels and BMD (Ferrari, Ahn-Luong, Garnero, Humphries, & Greenspan, 2003; Kimble et al., 1995; Scheidt-Nave et al., 2001; Weitzmann et al., 2001). Moreover, recently Barbour et al. demonstrated that elevated levels of inflammatory markers were associated with an increased risk of hip fractures in older women (Barbour et al., 2012). NLR has been emerged as a simple, inexpensive and useful marker of inflammation that has been related with various inflammatory, cardiovascular and neoplastic diseases. Further- more, it has been shown that NLR is superior to white blood cells in the prediction of adverse outcomes in patients with cardiovascular diseases and malignancies (Azab et al., 2012; Gomez et al., 2008; Gurm et al., 2003; Papa et al., 2008; Tamhane et al., 2008; Walsh, Cook, Goulder, Justin, & Keeling, 2005). Recognizing the absence of research investigating the relation- ship between NLR and osteoporosis, this study was undertaken to Archives of Gerontology and Geriatrics 57 (2013) 81–85 A R T I C L E I N F O Article history: Received 10 October 2012 Received in revised form 12 February 2013 Accepted 14 February 2013 Available online 13 March 2013 Keywords: BMD NLR Inflammation A B S T R A C T 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 < 0.001; 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. ß 2013 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +90 342 341 66 89; fax: +90 342 360 60 60. E-mail address: zaodr79@yahoo.com (Z.A. O ¨ ztu ¨ rk). Contents lists available at SciVerse ScienceDirect Archives of Gerontology and Geriatrics jo ur n al ho mep ag e: www .elsevier .c om /lo cate/ar c hg er 0167-4943/$ – see front matter ß 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.archger.2013.02.005