Dyslipidemia, whose prevalence increases with aging, is widely recognized as a contributor to chronic inflammation. However, the association between serum lipoprotein indices reflecting lipid metabolism and osteoarthritis, an age-related disease, has not been fully elucidated. This study aimed to evaluate the relationship between serum lipoprotein indices, remnant cholesterol, and osteoarthritis among older adults. This cross-sectional study used raw data from the 2018–2020 Korea National Health and Nutrition Examination Survey (KNHANES). Serum lipid parameters total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were analyzed. Remnant cholesterol was calculated as TC − (LDL-C + HDL-C). The association between serum lipid indices and osteoarthritis was assessed using multivariable regression analysis (logistic regression) adjusting for potential confounders. Among 296 participants aged ≥65 years, 89 (30.06%) reported having osteoarthritis. The osteoarthritis group had significantly higher remnant cholesterol (P < 0.05) and significantly lower HDL-C (P < 0.05) than the non-osteoarthritis group. There were no significant differences between groups in TC, LDL-C, or TG. In multivariable analyses, only remnant cholesterol showed a significant positive association with osteoarthritis risk (OR = 1.28, 95% CI: 1.08–1.54, P < 0.05). Although serum lipid abnormalities have been suggested as risk factors for osteoarthritis, the underlying epidemiologic mechanisms remain unclear. In this study, remnant cholesterol was significantly associated with osteoarthritis in older adults. Further studies are needed to clarify how metabolic factors such as hypercholesterolemia contribute to the development and progression of osteoarthritis. In addition, cholesterol reduction through lifestyle interventions—such as improving nutritional status and increasing physical activity—may represent a potential strategy for preventing and managing osteoarthritis in certain high-risk groups, and may help inform lifestyle guidance and identify novel targets for pharmacotherapy.

• 노희(강동대학교 치위생학과) | Hee Noh (Department of Dental Hygiene, Gangdong University, Chungbuk, Korea)
• 김병국(전남대학교 치의학전문대학원 구강내과학교실) | Byung-Gook Kim (Department of Oral Medicine, School of Dentistry, Chonnam National University, Gwangju, Korea) Corresponding author