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已发表论文
中国老年患者骨质疏松性骨折中 NLR 与铁蛋白的相关性
Authors Jiao HT, Liu ZH, Zhou P, Yuan S, Lu K, Li C
Received 13 April 2025
Accepted for publication 14 November 2025
Published 4 December 2025 Volume 2025:18 Pages 17045—17056
DOI https://doi.org/10.2147/JIR.S534180
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Ujjwol Risal
Hao-Tian Jiao,1,2,* Zhou-Hang Liu,2,3,* Peng Zhou,1,2,* Shuai Yuan,2,3 Ke Lu,1,2 Chong Li1,2
1Department of Orthopedics, the First People’s Hospital of Kunshan, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China; 2Kunshan Biomedical Big Data Innovation Application Laboratory, Jiangsu, 215300, People’s Republic of China; 3Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Chong Li, Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, Jiangsu, 215300, People’s Republic of China, Tel +86 0512 57532362, Email lichong1705@163.com Ke Lu, Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, Jiangsu, 215300, People’s Republic of China, Tel +86 0512 57532362, Email sgu8434@sina.com
Background: Research on the connection between serum ferritin levels and the neutrophil-to-lymphocyte ratio (NLR) in individuals with osteoporotic fractures (OPF) are currently limited. This study aims to investigate the relationship between the NLR and serum ferritin levels, with the goal of offering a more convenience method for assessing iron stores and inflammatory response in clinical settings.
Methods: A retrospective cross-sectional analyzed 4782 patients with OPF. Initial measurements included serum ferritin and NLR. The analysis accounted for various confounders. Furthermore, techniques such as multivariable linear regression, smooth curve fitting, and threshold analysis techniques were utilized.
Results: A strong association was observed between serum ferritin levels and the NLR in patients with OPF (β = 6.36, 95% CI, 2.02, 10.65, P-value < 0.01). The recognized threshold was 5.31. When levels dropped below this point (< 5.31), there was a notable rise in serum ferritin (β= 32.08; 95% CI, 12.97, 51.20, P-value < 0.01). This study discovered a threshold effect between serum ferritin and NLR.
Discussion: Recognizing this threshold effect holds substantial clinical importance, as it could provide a novel approach for assessing inflammation levels and iron reserves in patients with OPF. Higher or lower NLR may be relevant for identifying iron status. Clinicians may assess the iron status of patients with OPF by monitoring NLR, which may serve as an indicator of their iron reserves. This information can facilitate the formulation of targeted strategies for diagnosis and treatment. Nevertheless, further detailed studies are needed to confirm the current results.
Conclusion: The study reveals a threshold effect between serum ferritin and NLR in patients with OPF, showing a positive correlation, particularly when NLR is below 5.31. This discovery reveals that NLR may serve as a biomarker for rapidly evaluating iron reserves in patients with OPF. Therefore, clinicians may incorporate NLR as a potential biomarker for quick iron evaluation to determine the next step of comorbidity screening and treatment plan.
Keywords: serum ferritin, neutrophil-to-lymphocyte ratio, osteoporosis, osteoporotic fractures
1Department of Orthopedics, the First People’s Hospital of Kunshan, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China; 2Kunshan Biomedical Big Data Innovation Application Laboratory, Jiangsu, 215300, People’s Republic of China; 3Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Chong Li, Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, Jiangsu, 215300, People’s Republic of China, Tel +86 0512 57532362, Email lichong1705@163.com Ke Lu, Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, Jiangsu, 215300, People’s Republic of China, Tel +86 0512 57532362, Email sgu8434@sina.com
Background: Research on the connection between serum ferritin levels and the neutrophil-to-lymphocyte ratio (NLR) in individuals with osteoporotic fractures (OPF) are currently limited. This study aims to investigate the relationship between the NLR and serum ferritin levels, with the goal of offering a more convenience method for assessing iron stores and inflammatory response in clinical settings.
Methods: A retrospective cross-sectional analyzed 4782 patients with OPF. Initial measurements included serum ferritin and NLR. The analysis accounted for various confounders. Furthermore, techniques such as multivariable linear regression, smooth curve fitting, and threshold analysis techniques were utilized.
Results: A strong association was observed between serum ferritin levels and the NLR in patients with OPF (β = 6.36, 95% CI, 2.02, 10.65, P-value < 0.01). The recognized threshold was 5.31. When levels dropped below this point (< 5.31), there was a notable rise in serum ferritin (β= 32.08; 95% CI, 12.97, 51.20, P-value < 0.01). This study discovered a threshold effect between serum ferritin and NLR.
Discussion: Recognizing this threshold effect holds substantial clinical importance, as it could provide a novel approach for assessing inflammation levels and iron reserves in patients with OPF. Higher or lower NLR may be relevant for identifying iron status. Clinicians may assess the iron status of patients with OPF by monitoring NLR, which may serve as an indicator of their iron reserves. This information can facilitate the formulation of targeted strategies for diagnosis and treatment. Nevertheless, further detailed studies are needed to confirm the current results.
Conclusion: The study reveals a threshold effect between serum ferritin and NLR in patients with OPF, showing a positive correlation, particularly when NLR is below 5.31. This discovery reveals that NLR may serve as a biomarker for rapidly evaluating iron reserves in patients with OPF. Therefore, clinicians may incorporate NLR as a potential biomarker for quick iron evaluation to determine the next step of comorbidity screening and treatment plan.
Keywords: serum ferritin, neutrophil-to-lymphocyte ratio, osteoporosis, osteoporotic fractures