Platelet/lymphocyte ratio is an independent predictor for osteoporosis

Semra Eroglu, Gulsah Karatas


Objectives: To investigate the intercourse between the platelet/lymphocyte (P/L) and neutrophil/lymphocyte ratio (N/L), and vitamin D (Vit-D) levels in low bone mineral density (BMD) of women.


Methods: Two hundred fifty-two postmenopausal female outpatients who were admitted to the obstetrics and gynecology and physical therapy clinics between July 2016 and December 2017 were retrospectively analyzed. The patients were grouped in relation to their T-score (normal [n=92], osteopenia [n=112], and PMO [n=48]). The serum levels of P/L, N/L, Vit-D, BMD and complete blood count of the patients were retrospectively examined.


Results: The median P/L was significantly higher and Vit-D levels were significantly lower in the PMO group (130.75 [52.89-385] versus 123.05 [54-232.5], p=0.02 and 15.4 [4-34] versus 20.1 [4-47], p=0.003). While BMD and P/L were negatively correlated, a positive correlation between BMD and Vit-D was found. Vitamin D levels were negatively correlated with P/L (p less than 0.001) and N/L (p=0.04). Older age (≥65 years), Vit-D deficiency and P/L values greater than 125.06 were found as independent prognostic factors for PMO in regression analysis.


Conclusion: Higher P/L seems to be a quite simple marker to help predict postmenopausal PMO. As seen in our study, having low levels of Vit-D is crucial for PMO.


Saudi Med J 2019; Vol. 40 (4): 360-366

How to cite this article:
Eroglu S, Karatas G. Platelet/lymphocyte ratio is an independent predictor for osteoporosis. Saudi Med J. 2019 Apr;40(4):360-366. doi: 10.15537/smj.2019.4.24009.



platelet; lymphocyte; ratio; vitamin D; osteoporosis; postmenopausal

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Eastell R, O’Neill TW, Hofbauer LC, Langdahl B, Reid IR, Gold DT, et al. Postmenopausal osteoporosis. Nat Rev Dis Primers 2016; 2: 16069.

Curtis EM, Moon RJ, Dennison EM, Harvey NC, Cooper C. Recent advances in the pathogenesis and treatment of osteoporosis. Clin Med (Lond) 2015; 15: s92-s96.

Holm JP, Hyldstrup L, Jensen JB. Time trends in osteoporosis risk factor profiles: a comparative analysis of risk factors, comorbidities, and medications over twelve years. Endocrine 2016; 54: 241-255.

Zhen D, Liu L, Guan C, Zhao N, Tang X. High prevalence of vitamin D deficiency among middle-aged and elderly individuals in northwestern China: its relationship to osteoporosis and lifestyle factors. Bone 2015; 71: 1-6.

Jamka M, Woźniewicz M, Walkowiak J, Bogdański P, Jeszka J, Stelmach-Mardas M. The effect of vitamin D supplementation on selected inflammatory biomarkers in obese and overweight subjects: a systematic review with meta-analysis. Eur J Nutr 2016; 55: 2163-2176.

Gravallese EM, Goldring SR, Schett G. The role of the immune system in the local and systemic bone loss of inflammatory arthritis. Osteoimmunology (Second edition) 2016; 241-256.

Jafari T, Faghihimani E, Feizi A, Iraj B, Javanmard SH, Esmaillzadeh A, et al. Effects of vitamin D-fortified low fat yogurt on glycemic status, anthropometric indexes, inflammation, and bone turnover in diabetic postmenopausal women: A randomised controlled clinical trial. Clin Nutr 2016; 35: 67-76.

Harmandar FA, Can H, Cekin AH, Uyar S. Incidence of low bone mineral density and contributing factors in inflammatory bowel disease [Internet]. akademik gastroenteroloji dergisi. [Updated 2016; Accessed 2019 January 11]. Available from:

El Maghraoui A, Sadni S, Rezqi A, Bezza A, Achemlal L, Mounach A. Does Rheumatoid Cachexia Predispose Patients with Rheumatoid Arthritis to Osteoporosis and Vertebral Fractures? J Rheumatol 2015; 42: 1556-1562.

Salman-Monte TC, Torrente-Segarra V, Muñoz-Ortego J, Mojal S, Carbonell-Abelló J. Prevalence and predictors of low bone density and fragility fractures in women with systemic lupus erythematosus in a Mediterranean region. Rheumatol Int 2015; 35: 509-515.

Sponholtz TR, Zhang X, Fontes JD, Meigs JB, Cupples LA, Kiel DP, et al. Association between inflammatory biomarkers and bone mineral density in a community-based cohort of men and women. Arthritis Care Res (Hoboken) 2014; 66: 1233-1240.

Lin CC, Li TC, Liu CS, Yang CW, Lin CH, Hsiao JH, et al. Associations of TNF-α and IL-6 polymorphisms with osteoporosis through joint effects and interactions with LEPR gene in Taiwan: Taichung Community Health Study for Elders (TCHS-E). Mol Biol Rep 2016; 43: 1179-1191.

Berglundh S, Malmgren L, Luthman H, McGuigan F, Åkesson K. C-reactive protein, bone loss, fracture, and mortality in elderly women: a longitudinal study in the OPRA cohort. Osteoporos Int 2015; 26: 727-735.

Yan P, Xu Y, Wan Q, Feng J, Yang J, Li H, et al. Impact of MPV and PDW on bone mineral density and their relationship with osteoporosis in Chinese patients with type 2 diabetes. Int J Clin Exp Med 2018; 11: 2337-2349.

Koupenova M, Clancy L, Corkrey HA, Freedman JE. Circulating Platelets as Mediators of Immunity, Inflammation, and Thrombosis. Circ Res 2018; 122: 337-351.

Kapur R, Zufferey A, Boilard E, Semple JW. Nouvelle cuisine: platelets served with inflammation. J Immunol 2015; 194: 5579-5587.

Xu ZS, Zhang FP, Zhang Y, Ou-Yang YP, Yu XW, Wang WL, et al. Prognostic role of the pre-treatment platelet-lymphocyte ratio in pancreatic cancer: a meta-analysis. Oncotarget 2017; 8: 99003-99012.

Sato N, Kinoshita A, Imai N, Akasu T, Yokota T, Iwaku A, et al. Inflammation-based prognostic scores predict disease severity in patients with acute cholecystitis. Eur J Gastroenterol Hepatol 2018; 30: 484-489.

Guo J, Wu M, Guo L, Zuo Q. Pretreatment blood neutrophil/lymphocyte ratio is associated with metastasis and predicts survival in patients with pancreatic cancer. Bull Cancer 2018; 105: 146-154.

Yu XY, Li XS, Li Y, Liu T, Wang RT. Neutrophil-lymphocyte ratio is associated with arterial stiffness in postmenopausal women with osteoporosis. Arch Gerontol Geriatr 2015; 61: 76-80.

Fisher A, Srikusalanukul W, Fisher L, Smith P. The Neutrophil to Lymphocyte Ratio on Admission and Short-Term Outcomes in Orthogeriatric Patients. Int J Med Sci 2016; 13: 588-602.

Yilmaz H, Uyfun M, Yilmaz TS, Namuslu M, Inan O, Taskin A, et al. Neutrophil-lymphocyte ratio may be superior to C-reactive protein for predicting the occurrence of postmenopausal osteoporosis. Endocr Regul 2014; 48: 25-33.

Koseoglu SB. Bone loss & platelet-to-lymphocyte ratio. Biomark Med 2017; 11: 5-10.

Miller AJ, Jones C, Liss F, Abboudi J, Kirkpatrick W, Beredjiklian P. Qualitative Evaluation of Digital Hand X-rays Is Not a Reliable Method to Assess Bone Mineral Density. Arch Bone Jt Surg 2017; 5: 10-13.

Lim HS, Park YH, Kim SK. Relationship between Serum Inflammatory Marker and Bone Mineral Density in Healthy Adults. J Bone Metab 2016; 23: 27-33.

Wu ZJ, He JL, Wei RQ, Liu B, Lin X, Guan J, et al. C-reactive protein and risk of fracture: a systematic review and dose-response meta-analysis of prospective cohort studies. Osteoporos Int 2015; 26: 49-57.

Oei L, Campos-Obando N, Dehghan A, Oei EH, Stolk L, van Meurs JB, et al. Dissecting the relationship between high-sensitivity serum C-reactive protein and increased fracture risk: the Rotterdam Study. Osteoporos Int 2014; 25: 1247-1254.

Al-Daghri NM, Aziz I, Yakout S, Aljohani NJ, Al-Saleh Y, Amer OE, et al. Inflammation as a contributing factor among postmenopausal Saudi women with osteoporosis. Medicine (Baltimore) 2017; 96: e5780.

Huang C, Li S. Association of blood neutrophil lymphocyte ratio in the patients with postmenopausal osteoporosis. Pak J Med Sci 2016; 32: 762-765.

Guo L, Gao Z, Ge H. Effects of serum 25-hydroxyvitaminD level on decreased bone mineral density at femoral neck and total hip in Chinese type 2 diabetes. PLoS One 2017; 12: e0188894.

Brincat M, Gambin J, Brincat M, Calleja-Agius J. The role of vitamin D in osteoporosis. Maturitas 2015; 80: 329-332.

Akbas EM, Gungor A, Ozcicek A, Akbas N, Askin S, Polat M. Vitamin D and inflammation: evaluation with neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio. Arch Med Sci 2016; 12: 721-727.

Tabatabaeizadeh SA, Avan A, Bahrami A, Khodashenas E4, Esmaeili H, Ferns GA, et al. High Dose Supplementation of Vitamin D Affects Measures of Systemic Inflammation: Reductions in High Sensitivity C-Reactive Protein Level and Neutrophil to Lymphocyte Ratio (NLR) Distribution. J Cell Biochem 2017; 118: 4317-4322.


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