Cholesterol and Musculoskeletal Health

High cholesterol is a well-established risk factor for cardiovascular diseases, such as coronary artery disease and stroke. It is primarily associated with the development of atherosclerosis, characterised by the accumulation of cholesterol-laden plaques in arterial walls (Libby et al., 2019; Virmani et al., 2020). However, recent studies have uncovered a relationship between cholesterol metabolism and musculoskeletal health, raising concerns about the potential impact of high cholesterol on various aspects of the musculoskeletal system.

Impact on Bone Health

Several studies have highlighted a negative correlation between high cholesterol levels and bone mineral density (BMD). Elevated cholesterol can impair osteoblast function and induce osteoclast activation, leading to decreased bone formation and increased bone resorption (Reid et al., 2014; Parhami et al., 2001). Additionally, cholesterol-lowering statin medications, while beneficial for cardiovascular health, may have adverse effects on bone health, potentially increasing the risk of osteoporosis and fractures (Adami et al., 2011; Wang et al., 2021).

Association with Joint Diseases

Evidence suggests that high cholesterol may contribute to the pathogenesis of osteoarthritis (OA) and rheumatoid arthritis (RA), two common degenerative joint diseases. Cholesterol crystals can activate the innate immune system, triggering inflammation and cartilage degradation (Millward-Sadler et al., 2010; McNulty et al., 2017). Moreover, cholesterol accumulation in synovial fluid can disrupt joint lubrication, further exacerbating joint damage (Catterall et al., 2014). Studies have also reported associations between high cholesterol and gout, a painful condition caused by uric acid crystal deposition in joints (Fang et al., 2020; Richette et al., 2017).

Tendon Degeneration, Impaired Tissue Healing, and Intervertebral Disc Degeneration

We know that elevated cholesterol levels can play a significant role in the development of atherosclerosis. Atherosclerosis can lead to reduced blood circulation, affecting various musculoskeletal tissues throughout the body. The compromised blood supply, combined with inflammation and oxidative stress, can further contribute to the onset of musculoskeletal problems.

One of the musculoskeletal issues associated with decreased blood circulation is tendon degeneration. Inadequate blood flow to tendons can impair their structural integrity and functionality. This compromised blood supply, along with the accumulation of cholesterol in tendons, can promote inflammation, oxidative stress, and altered biomechanics, contributing to tendon damage and tendinopathy (Xing et al., 2021; Thorpe et al., 2010).

Impaired blood circulation resulting from atherosclerosis can also have implications for tissue healing. Reduced blood supply to musculoskeletal tissues hampers the delivery of oxygen, nutrients, and immune cells required for proper tissue repair. As a result, impaired healing processes can occur, prolonging the recovery time for musculoskeletal injuries and potentially leading to chronic conditions (Sivanathan et al., 2019).

Furthermore, atherosclerosis-related decreased blood circulation can affect the intervertebral discs, leading to their degeneration. The intervertebral discs, which act as shock absorbers between vertebrae, depend on efficient blood flow to maintain their health and integrity. Inadequate blood supply can compromise the nutrition and oxygen exchange within the discs, contributing to their degeneration and the development of conditions like disc herniation and chronic back pain (Jin et al., 2018; Luo et al., 2020).

Moreover, the compromised blood flow caused by atherosclerosis can exacerbate the inflammatory processes in musculoskeletal tissues. Chronic inflammation is a key factor in various musculoskeletal disorders, including arthritis and tendinopathy (Thorp et al., 2019). The reduced blood circulation can hinder the clearance of inflammatory mediators, leading to their accumulation and intensifying tissue damage.

Clinical Implications and Management

Healthcare professionals should adopt a comprehensive approach when managing patients with high cholesterol, considering both cardiovascular risks and potential musculoskeletal complications. Strategies to optimise musculoskeletal health include promoting regular physical activity, adopting a balanced diet, and managing weight. Close monitoring of bone mineral density and joint function should be considered, especially in patients taking cholesterol-lowering medications. Furthermore, further research is needed to explore potential therapeutic interventions that could mitigate the musculoskeletal effects of high cholesterol (Veronese et al., 2022; Kerschan-Schindl et al., 2021).


High cholesterol, a known risk factor for cardiovascular diseases, also has significant implications for musculoskeletal health. Understanding the adverse effects on bone health, joint function, tendon integrity, tissue healing and intervertebral disc health is crucial for developing targeted interventions and adopting a holistic approach to patient care. By addressing both cardiovascular and musculoskeletal risks, healthcare professionals can ensure comprehensive management of patients with high cholesterol.


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