Is vascular calcification associated with bone mineral density and osteoporotic fractures in ambulatory, elderly women?

Associations between bone mineral density and abdominal aortic calcification: Results of a nationwide survey

BACKGROUND AND AIMS

Vascular calcification has been linked to bone mineral density (BMD). This study aimed to investigate the association between BMD and abdominal aortic calcification (AAC).

METHODS AND RESULTS

Data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) were utilized. Participants lacking BMD and AAC score data were excluded. BMD at the femoral neck was measured using dual-energy X-ray absorptiometry. AAC scores were assessed using the Kauppila scoring system, with AAC defined as a score greater than zero, and severe AAC defined as a score greater than six. Weighted multivariable regression analysis and subgroup analysis were conducted to examine the independent relationship between BMD and AAC score, AAC, and severe AAC. A total of 2965 participants were included. After adjusting for multiple covariates, BMD showed a negative association with higher AAC scores (β = -0.17, 95% CI -0.29, -0.05, p = 0.0066). The odds of having AAC and severe AAC decreased by 9% and 16%, respectively, for every one-unit increase in BMD (AAC: odds ratio [OR] = 0.91, 95% CI 0.82, 1.00, p = 0.0431; severe AAC: OR = 0.84, 95% CI 0.71, 0.99, p = 0.0334).

CONCLUSION

Low BMD is associated with higher AAC scores and an increased risk of AAC and severe AAC. Considering the detrimental impact of low BMD on cardiovascular health, individuals with AAC should be evaluated for osteopenia and osteoporosis in clinical settings.

Effects of Multiwall Carbon Nanotubes on Premature Kidney Aging: Biochemical and Histological Analysis

Carbon nanotubes (CNTs) have gained much attention due to their superb properties, which make them promising options for the reinforcing composite materials with desirable mechanical properties. However, little is known about the linkage between lung exposure to nanomaterials and kidney disease. In this study, we compared the effects on the kidneys and aging for two different types of multiwall carbon nanotubes (MWCNTs): pristine MWCNTs (PMWCNTs) and acid-treated MWCNTs (TMWCNTs), with TMWCNTs being the preferred form for use as a composite material due to its superior dispersion properties. We used tracheal instillation and maximum tolerated dose (MTD) for both types of CNTs. MTD was determined as a 10% weight loss dose in a 3-month subchronic study, and the appropriate dosage for 1-year exposure was 0.1 mg/mouse. Serum and kidney samples were analyzed using ELISA, Western blot, and immunohistochemistry after 6 months and 1 year of treatment. PMWCNT-administered mice showed the activation of pathways for inflammation, apoptosis, and insufficient autophagy, as well as decreased serum Klotho levels and increased serum levels of DKK-1, FGF-23, and sclerostin, while TMWCNTs did not. Our study suggests that lung exposure to PMWCNTs can induce premature kidney aging and highlights a possible toxic effect of using MWCNTs on the kidneys in the industrial field, further highlighting that dispersibility can affect the toxicity of the nanotubes.

Measuring forearm bone density instead of lumbar spine bone density improves the sensitivity of diagnosing osteoporosis in older adults with cardiovascular diseases: Data from SARCOS study

Introduction

In older individuals with cardiovascular diseases, it has been challenging to diagnose osteoporosis due to aortic calcification and degenerative processes in the spine of older adults, especially in very old adults.

Aim

To assess whether the distal forearm BMD with the proximal femur BMD has greater sensitivity for the diagnosis of osteoporosis than the lumbar spine BMD with the proximal femur BMD.

Methods

We evaluated 515 older adults with cardiovascular disease from the SARCOS study and stratified them into under and over 80-year-old age groups and according to gender. Two diagnostic criteria were used to assess osteoporosis, SPF (lumbar spine and proximal femur BMD) and DFF (distal forearm and proximal femur BMD), which were compared with the multiple bone sites (MS) criteria (lumbar spine, distal radius, femoral neck, and total femur BMD).

Results

43.9% were aged ≥80 years. Osteoporosis by SPF was diagnosed in 34% (n = 175), by DFF in 42.2% (n = 216), and by MS in 46.8% (n = 241). The characteristics of the three groups were similar. For every 100 older individuals with osteoporosis based on MS, 27 were not diagnosed by the SPF, and nine were not diagnosed by DFF (p = 0.001). The SPF did not diagnose osteoporosis in 23/100 in older adults aged <80 years, while DFF did not diagnose 16/100 (p.ns). In adults aged ≥80 years, the SPF did not identify osteoporosis in 31/100 older adults, while the DFF failed to identify it in only 5/100 (p < 0.001). In men and women aged ≥80 years, DFF showed higher sensitivity for the diagnosis of osteoporosis compared to the SPF criterion.

Conclusion

In the elderly population with cardiovascular disease evaluated in our study, the use of distal forearm BMD instead of lumbar spine BMD, associated with proximal femur BMD, showed higher sensitivity for the diagnosis of osteoporosis, regardless of gender, and especially among the very older adults.

•

Diagnosis of osteoporosis (OP) in the elderly with cardiovascular disease is challenging.

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We evaluated the sensitivity of distal forearm (DF) BMD vs. lumbar spine (LS) BMD.

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LS BMD did not diagnose OP in 27/100, and DF BMD in 9/100 (p = 0.001).

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LS BMD did not identify OP in 31/100, and DF BMD in 5/100 (p < 0.001) aged ≥80 years.

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DF BMD showed higher sensitivity for diagnosing osteoporosis, regardless of gender.

The association between low bone mineral density and coronary artery calcification in osteoporotic and non-osteoporotic patients in a tertiary center in Saudi Arabia

BACKGROUND

Cardiovascular disease (CVD) and osteoporosis are major health-care concerns worldwide. The evidence is contradictory on whether a relationship exists between low bone mineral density (BMD) determined by dual-energy absorptiometry (DXA scan) and coronary artery calcification (CAC) measured by computed tomography. Currently, there are no data on patients from Saudi Arabia.

OBJECTIVE

Examine the relationship between CAC and BMD in both genders and study the influence of traditional coronary artery disease (CAD) risk factors and osteoporosis.

DESIGN

Retrospective, cross-sectional, analytical.

SETTING

Single tertiary care center.

PATIENTS AND METHODS

We searched radiology databases for patients who underwent both DXA and CAC score scanning within six months of each other. The inclusion criterion was an absence of any history of CAD.

MAIN OUTCOME MEASURE

Association between osteoporosis and CAC.

SAMPLE SIZE

195 (34 osteoporosic, 161 normal BMD or osteopenic) RESULTS: Most of the study population (57.4%) were females. The mean age of all patients was 63.6 (10.1) years. Participants with CAC scores of 0 were significantly younger than those who had CAC scores >0. The presence of diabetes mellitus, hypertension, and hypercholesterolemia was higher in patients with CAC scores >0. CAC score and other CAD risk factors were not significantly different between the osteoporotic and nonosteoporotic groups, except for body mass index. A high CAC score (>100) was present in 28%, 20%, 11%, and 30% of participants with no osteoporosis, osteoporosis of the lumbar spine, osteoporosis of the femoral neck, and participants with osteoporosis of both the lumbar spine and femoral neck, respectively (P=.762), suggesting there is no association between CAC and the presence of osteoporosis.

CONCLUSIONS

Osteoporosis is not associated with higher CAC scores in Saudi Arabia and CAD risk factors are not significantly prevalent in osteoporosis. It appears that CAC and osteoporosis are independent age-related diseases that share common risk factors.

LIMITATIONS

Single-center, retrospective.

CONFLICT OF INTEREST

None.

The Role of Gut Dysbiosis in the Bone-Vascular Axis in Chronic Kidney Disease

Patients with chronic kidney disease (CKD) are at increased risk of bone mineral density loss and vascular calcification. Bone demineralization and vascular mineralization often concur in CKD, similar to what observed in the general population. This contradictory association is commonly referred to as the 'calcification paradox' or the bone-vascular axis. Mounting evidence indicates that CKD-associated gut dysbiosis may be involved in the pathogenesis of the bone-vascular axis. A disrupted intestinal barrier function, a metabolic shift from a predominant saccharolytic to a proteolytic fermentation pattern, and a decreased generation of vitamin K may, alone or in concert, drive a vascular and skeletal pathobiology in CKD patients. A better understanding of the role of gut dysbiosis in the bone-vascular axis may open avenues for novel therapeutics, including nutriceuticals.

Relationship of volumetric bone mineral density by quantitative computed tomography with abdominal aortic calcification

OBJECTIVE

This multicenter study aimed to evaluate the association between volumetric bone mineral density (vBMD) and abdominal aortic calcification (AAC) in a Chinese population.

METHODS

Quantitative computed tomography (QCT) and Agatston score (AS) were used to measure vBMD and AAC, respectively, in 3457 participants during 2013-2017. The association between vBMD and AAC was assessed using multivariate regression analysis, adjusted for age, residence, education, body mass index, and other cardiovascular risk factors.

RESULTS

The mean age of women and men was 61.4 and 62.7 years, respectively. In total, 30.4% of women and 37.7% of men were found to have AAC. After full adjustment, higher vBMD was associated with lower AAC score (β, -0.095; 95% confidence interval [CI], -0.167 to -0.024; P = 0.0087) and lower AAC prevalence (odds ratio [OR], 0.873; 95% CI, 0.824 to 0.924; P < 0.0001) in men. Inverse trends were also observed in the association of vBMD quartile with AAC severity (lowest vs highest quartile; β = 0.235; 95% CI, 0.011 to 0.459; P_trend < 0.0001) and AAC prevalence (lowest vs highest quartile; OR = 1.329; 95% CI, 1.087 to 1.625; P_trend < 0.0001) in men. However, no significant result was obtained in women, except for the association between quartiles of vBMD and AAC score.

CONCLUSIONS

In our study, vBMD was inversely associated with AAC among men independent of age and shared risk factors. However, the association was not significant among women.

Bone-Vascular Axis in Chronic Kidney Disease

Patients with chronic kidney disease (CKD) are at increased risk of osteoporosis and vascular calcification. Bone demineralization and vascular mineralization go often hand in hand in CKD, similar to as in the general population. This contradictory association is independent of aging and is commonly referred to as the "calcification paradox" or the bone-vascular axis. Various common risk factors and mechanisms have been identified. Alternatively, calcifying vessels may release circulating factors that affect bone metabolism, while bone disease may infer conditions that favor vascular calcification. The present review focuses on emerging concepts and major mechanisms involved in the bone-vascular axis in the setting of CKD. A better understanding of these concepts and mechanisms may identify therapeutics able to target and exert beneficial effects on bone and vasculature simultaneously.

Abdominal aortic calcification and the risk of bone fractures: a meta-analysis of prospective cohort studies

The relationship between abdominal aortic calcification (AAC) and bone fracture has been examined by some observational studies, but the results remain discordant. Therefore, we aimed to assess the link between them by conducting a meta-analysis of prospective studies. Relevant studies were identified by searching PubMed and EMBASE databases until the end of December 2016. Summary relative risks (RRs) and 95% confidence intervals (CIs) for associations between AAC and fracture risk were estimated with fixed- or random- effects models. Seven prospective studies were included in the final analysis. The summarized RRs of any type of fractures for the highest compared with the lowest category of AAC were 1.64 (95% CI 1.30-2.07, P = 0.000) with mild heterogeneity (I ² = 30.1%, P = 0.188). Subgroup analysis showed that the association between AAC and fracture was not significantly modified by gender and follow-up length. Risks were similar when analyses were restricted to the studies with adjustment for bone mineral density (BMD) (RR = 1.76, 95% CI 1.31-2.38, P = 0.000, I ² = 49.1%). For the specific type of fracture, severe AAC was significantly related with hip fracture (RR = 1.64, 95% CI 1.22-2.20, P = 0.001, n = 5), but not with vertebral (RR = 1.45, 95% CI 0.81-2.58, P = 0.213, n = 3) or non-vertebral fracture (RR = 1.35, 95% CI 0.96-1.88, P = 0.081, n = 3). There was no evidence of publication bias. Our findings demonstrated that AAC was significantly and independently associated with a higher fracture risk, especially for hip fracture.

Diabetes and Abdominal Aortic Calcification-a Systematic Review

PURPOSE OF REVIEW

A systematic literature review was performed to evaluate diabetes mellitus (DM) as a risk factor of abdominal aortic calcification (AAC), and address factors that might contribute to the development of AAC in DM patients.

RECENT FINDINGS

DM is an independent risk factor of AAC development. Bone metabolism along with lifestyle factors among DM patients makes them more prone to AAC. Hip and vertebral fractures, high phosphate, smoking, hypertension, and low osteocalcin could make DM patients prone to AAC. Low levels of high-density lipoprotein (HDL), high low-density lipoprotein (LDL), high total cholesterol/HDL ratio, low bone mineral density (BMD) may be risk factors, but the literature is more ambiguous. Body mass index (BMI) does not appear to increase risk of AAC. High phosphate levels and low osteocalcin levels seem to be biomarkers of AAC in patients with diabetes. However, the association between DM and AAC is complicated.

Abdominal aortic calcification on dual-energy X-ray absorptiometry: Methods of assessment and clinical significance

Abdominal aortic calcification (AAC) can be accurately recognized on lateral spine images intended for vertebral fracture assessment, that are obtained with dual-energy X-ray absorptiometry (DXA). Greater amounts of AAC are common in the older population for whom DXA is routinely done, and have been consistently associated with incident atherosclerotic cardiovascular disease (ASCVD) events. AAC has also been associated with incident fractures in some prospective studies, but not in others. However, further research is needed to quantify the extent to which measurement of AAC improves prediction of ASCVD events and its impact on physician and patient ASCVD risk management. Additionally, research to develop better, more precise, automated, quantitative methods of AAC assessment on lateral spine densitometric images will hopefully lead to better prediction of clinical outcomes. In conclusion, although the prime indication for densitometric lateral spine imaging remains vertebral fracture assessment, AAC that is found incidentally on lateral spine images should be reported, so that patients and their health care providers are aware of its presence.

A novel quantitative approach to the measurement of abdominal aortic calcification as applied to the Canadian Multicenter Osteoporosis Study (CaMOS)

BACKGROUND AND AIMS

Lateral spine radiographs provide an inexpensive resource for characterizing abdominal aortic calcification (AAC). A widely accepted measurement of AAC is the semi-quantitative technique generated by the Framingham Heart Study (F-AAC-24). We sought to develop an analytical method to quantify ACC (Q_AAC) on lateral spine radiographs and compare the finding to conventional subjective measurements.

METHODS

Severity of AAC was quantified by measuring pixel intensities in the user-defined region of the aorta with internal standardization to the vertebral endplates and background calibration to the density of the vertebral body. The association between bone mineral density (BMD) measured by dual energy X-ray absorptiometry (DXA) and AAC measured by Q_AAC, F-AAC-24 and a modified Framingham score (F-AAC-12) was determined in 110 participants of the Canadian Multicenter Osteoporosis Study (CaMOS).

RESULTS

The inter-observer reliability for the Q_AAC was slightly higher than with the visual and semi-quantitative Framingham method and the pseudo-colored images illustrate the potential to meaningfully resolve severity of calcification. There was a significant negative association between Q_AAC and BMD measures of the hip and spine. This association remained significant after adjustment for age, sex, estimated glomerular filtration rate, phosphate and hypertension. Significant predictors of F-ACC-12 and 24 included age and hypertension.

CONCLUSIONS

The Q_AAC is a reproducible approach to measuring AAC. Whether it is capable of monitoring subtle calcific changes over time requires further study. This technique could be applied to large studies that seek to determine the impact of interventions that modify bone density as a treatment for vascular calcification and cardiovascular disease in the general population.

Noncoronary Vascular Calcification, Bone Mineral Density, and Muscle Mass in Institutionalized Frail Nonagenarians

The purpose of this study was to compare the vascular calcification in thoracic aorta (TAC), abdominal aorta (AAC), iliac arteries (IAC), and femoral arteries (FAC) and bone mineral density (BMD) of the lumbar vertebrae between frail and robust nonagenarians, as well as to verify the associations between vascular calcification with BMD, muscle tissue quality, and quantity in both groups. Forty-two elderly subjects participated in this study: 29 institutionalized frail (92.0 ± 3.2 years) and 13 robust (89.0 ± 4.0 years) elderly participants. All patients underwent nonenhanced helical thoracic, abdominal, and thigh computed tomography. The frail group presented significantly greater FAC as well as less lumbar BMD than the robust group (p < 0.05). In the frail group, significant negative relationships were observed between the individual values of FAC with the individual values of BMD (r = -0.35 to -0.43, p < 0.05) and with the individual values of the quadriceps muscle quantity and quality (r = -0.52, p < 0.01), whereas no significant relationships were observed in the robust group. The robust group presented less vascular calcification and more BMD in the vertebral bodies than the frail group. In the frail group, femoral artery calcification was significantly negatively correlated with BMD, leg muscle quality, and muscle mass volume.

Aortic calcification was associated with risk of fractures: A meta-analysis

OBJECTIVE

The objective of this meta-analysis was to systematically assess the association between aortic calcification (AC) and fractures.

METHOD

Relevant studies were identified through searching PubMed, EMBASE and Cochrane databases before August 2014. Two investigators extracted data independently from the included studies. A random-effects model was derived to composite the pooled HRs or ORs for association of aortic calcification with fractures.

RESULTS

A total of 15 articles (21927 subjects) were included in the final meta-analyses. Comparing with non-calcification subjects, patients with aortic calcification were associated with increased risk of fractures (OR = 2.97, 95% CI: 1.98-4.42). Stratified analysis indicated that patients with aortic calcification showed a higher risk of fractures in hemodialysis patients (OR = 1.89, 95% CI: 1.33-2.67; I2 = 0.0%, p= 0.781) and general population (OR = 2.90, 95% CI: 1.80-4.80; I2 = 33.0%, p= 0.225), respectively. Similar significant association between severe aortic calcification and fractures were also observed.

CONCLUSIONS

Patients with aortic calcification or severe aortic calcification were associated with higher risk of fractures.

Systematic review and meta-analysis for the association of bone mineral density and osteoporosis/osteopenia with vascular calcification in women

AIM

The relationships of osteoporosis/osteopenia and bone mineral density (BMD) with vascular calcification (VC) remain controversial. Thus, we performed this systematic review and meta-analysis to evaluate the association between BMD, osteoporosis/osteopenia risk and VC.

METHODS

PubMed, Embase and Springer databases were searched from inception to March, 2015 for studies involving the association of vascular calcification with BMD and osteopenia/osteoporosis in women. A manual search of the references cited in the publications was also employed for more relevant studies. The heterogeneity was assessed using Cochran's Q statistic and I² test. Weighted mean difference (WMD) or odds ratio (OR) and 95% confidence interval (CI) in the VC group and control group were appropriately pooled.

RESULTS

Four studies were enrolled in the meta-analysis. The pooled effects indicated that the spine BMD (WMD = -0.08, 95% CI: -0.11 to -0.06) and hip BMD (WMD = -0.06, 95% CI: -0.10 to -0.07) in VC group were significantly lower than those in control group, respectively. Moreover, patients with VC were prone to develop osteoporosis (OR = 4.39, 95% CI: 2.82-6.83) and osteopenia (OR = 1.72, 95% CI: 1.14-2.60).

CONCLUSION

The results suggest that patients with VC have lower lumbar spine and hip BMD levels and increased risk for developing osteoporosis/osteopenia. Thus, VC patients should be evaluated for the presence of osteoporosis/osteopenia, as well as susceptibility to fractures.

Abdominal aortic calcification: A reappraisal of epidemiological and pathophysiological data

In men and women, there is a significant association between the risk of cardiovascular event (myocardial infarction, stroke) and risk of major fragility fracture (hip, vertebra). Abdominal aortic calcification (AAC) can be assessed using semiquantitative scores on spine radiographs and spine scans obtained by DXA. Severe AAC is associated with higher risk of major cardiovascular event. Not only does severe AAC reflect poor cardiovascular health status, but also directly disturbs blood flow in the vascular system. Severe (but not mild or moderate) AAC is associated with lower bone mineral density (BMD), faster bone loss and higher risk of major fragility fracture. The fracture risk remains increased after adjustment for BMD and other potential risk factors. The association between severe AAC and fracture risk was found in both sexes, mainly in the follow-ups of less than 10years. Many factors contribute to initiation and progression of AAC: lifestyle, co-morbidities, inorganic ions, dyslipidemia, hormones, cytokines (e.g. inflammatory cytokines, RANKL), matrix vesicles, microRNAs, structural proteins (e.g. elastin), vitamin K-dependent proteins, and medications (e.g. vitamin K antagonists). Osteogenic transdifferentiation of vascular smooth muscle cells (VSMC) and circulating osteoprogenitors penetrating into vascular wall plays a major role in the AAC initiation and progression. Vitamin K-dependent proteins protect vascular tunica media against formation of calcified deposits (matrix GLA protein, GLA-rich protein) and against VSMC apoptosis (Gas6). Further studies are needed to investigate clinical utility of AAC for the assessment of fracture and cardiovascular risk at the individual level and develop new medications permitting to prevent AAC progression.

Abdominal aortic calcification and risk of fracture among older women - The SOF study

Data concerning the link between severity of abdominal aortic calcification (AAC) and fracture risk in postmenopausal women are discordant. This association may vary by skeletal site and duration of follow-up. Our aim was to assess the association between the AAC severity and fracture risk in older women over the short- and long term. This is a case-cohort study nested in a large multicenter prospective cohort study. The association between AAC and fracture was assessed using Odds Ratios (OR) and 95% confidence intervals (95%CI) for vertebral fractures and using Hazard Risks (HR) and 95%CI for non-vertebral and hip fractures. AAC severity was evaluated from lateral spine radiographs using Kauppila's semiquantitative score. Severe AAC (AAC score 5+) was associated with higher risk of vertebral fracture during 4 years of follow-up, after adjustment for confounders (age, BMI, walking, smoking, hip bone mineral density, prevalent vertebral fracture, systolic blood pressure, hormone replacement therapy) (OR=2.31, 95%CI: 1.24-4.30, p<0.01). In a similar model, severe AAC was associated with an increase in the hip fracture risk (HR=2.88, 95%CI: 1.00-8.36, p=0.05). AAC was not associated with the risk of any non-vertebral fracture. AAC was not associated with the fracture risk after 15 years of follow-up. In elderly women, severe AAC is associated with higher short-term risk of vertebral and hip fractures, but not with the long-term risk of these fractures. There is no association between AAC and risk of non-vertebral-non-hip fracture in older women. Our findings lend further support to the hypothesis that AAC and skeletal fragility are related.

Vascular calcification and fracture risk

Osteoporosis and cardiovascular diseases are public health problems. Fragility fractures are associated with high risk of cardiovascular event and patients with cardiovascular diseases have higher risk of fracture. Severe abdominal aortic calcification (AAC) is associated with higher cardiovascular mortality and morbidity. Severe AAC is associated with higher risk of fracture. In cross-sectional studies severe AAC was associated with greater prevalence, higher number and greater severity of vertebral fractures after adjustment for confounders including bone mineral density (BMD). Prospective studies confirm the association between baseline AAC severity and prospectively assessed fracture risk in both sexes. Data on the link between AAC and BMD are discordant. Age, smoking, hypertension, diabetes mellitus, and low grade systemic inflammation are possible risk factors of severe AAC and fracture risk. However, in clinical studies, the link between AAC and fracture was significant after adjustment for these factors. Data on the association between calcification in other vascular beds and BMD are limited and discordant.

Bone health and coronary artery calcification: The Rotterdam Study

OBJECTIVES

Vascular calcification has been associated inconsistently to low bone mineral density and fractures. The aims of the present study were to investigate the associations between coronary artery calcification (CAC) and BMD change, BMD and fracture risk in elderly subjects of the population-based Rotterdam Study.

METHODS

BMD was assessed through dual-energy X-ray absorptiometry and CAC through Electron-Beam Computed Tomography in 582 men and 694 women. We investigated the associations between BMD change (6.4 years follow-up) and CAC at follow-up and between BMD and CAC (measured simultaneously). In sensitivity analyses we stratified analyses for estradiol levels in women. The association between CAC and fracture risk (9 years follow-up) was tested through competing-risks models. Models were sex-stratified and adjusted for age, body mass index, smoking, bisphosphonate use and age at menopause.

RESULTS

There was no association between BMD change and CAC in men. In women, each 1% increase in annual BMD loss was significantly associated with higher follow-up CAC [β = 0.22 (0.06-0.38), p=0.006; prevalence ratio: 4%]. Stratified analyses showed significant associations between BMD loss and follow-up CAC only in women with lower estradiol levels. We found no association between CAC and fracture risk and no association between BMD and CAC cross-sectionally.

CONCLUSIONS

BMD loss was associated with higher follow-up CAC in women, which might be related to low estrogen levels. No association between CAC and BMD or fracture risk was found. Further studies are required to elucidate the mechanisms that might underlie the association between BMD change and coronary calcification in women.

High hip fracture risk in men with severe aortic calcification: MrOS study

A significant link between cardiovascular disease and osteoporosis is established in postmenopausal women, but data for men are scarce. We tested the hypothesis that greater severity of abdominal aortic calcification (AAC) was associated with an increased risk of nonspine fracture in 5994 men aged ≥ 65 years. AAC was assessed on 5400 baseline lateral thoracolumbar radiographs using a validated visual semiquantitative score. Total hip bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry. Incident nonspine fractures were centrally adjudicated. After adjustment for age, body mass index (BMI), total hip BMD, fall history, prior fracture, smoking status, comorbidities, race, and clinical center, the risk of nonspine fracture (n=805) was increased among men with higher AAC (hazard ratio [HR] quartile 4 [Q4] [AAC score ≥ 9] versus quartile 1 [Q1] [0-1], 1.36; 96% confidence interval [CI], 1.10-1.68). This association was due to an increased risk of hip fracture (n=178) among men with higher AAC (HR Q4 versus Q1, 2.33; 95% CI, 1.41-3.87). By contrast, the association between AAC and the risk of nonspine, nonhip fracture was weaker and not significant (HR Q4 versus Q1, 1.22; 95% CI, 0.96-1.55). The findings regarding higher AAC and increased risk of fracture were not altered in additional analyses accounting for degree of trauma, estimated glomerular filtration rate, presence of lumbar vertebral fractures (which may bias AAC assessment), preexisting cardiovascular disease, ankle brachial index, or competing risk of death. Thus, in this large cohort of elderly men, greater AAC was independently associated with an increased risk of hip fracture, but not with other nonspine fractures. These findings suggest that AAC assessment may be a useful method for identification of older men at high risk of hip fracture.

Bone mineral density, vertebral fractures and body mass index in postmenopausal women with abdominal aortic calcification

BACKGROUND

Evidence suggest that there are connections between osteoporosis and cardiovascular diseases.

OBJECTIVES

The aim of the study was to analyze the relationship between radiological measurements of abdominal aorta calcifications (AAC) and bone mineral density (BMD) in postmenopausal women.

METHODS

In this cross-sectional study were included 125 postmenopausal women 50-84 years of age. BMD of the spine and hip was measured by dual energy X-ray absorptiometry (DXA). AAC were assessed by lateral radiographs of lumbar spine (L1-L4), using the antero-posterior severity score (0-24). Vertebral fractures were evaluated from T4 to L4 using Genant's semiquantitative method.

RESULTS

Forty-one (32.8%) patients had osteoporosis and 61 (48.8%) had AAC with a mean score of 3.1. Postmenopausal women with AAC were older and had significantly lower femoral neck and trochanteric BMD than subjects without AAC (all p < 0.01). There were no significant differences in the frequency of fractures between subjects with AAC and those without AAC (p > 0.05). In univariate analysis, age, height, weight, femoral and trochanter BMD were significantly associated with the severity of AAC score. In multiple regression analysis, femoral neck BMD, but not lumbar spine, trochanter BMD or age, was an independent predictor of AAC.

CONCLUSIONS

Reduced femoral neck BMD is negatively associated with the presence of AAC in postmenopausal women. The association between BMD and AAC seems to be age-independent, which suggests a common pathogenesis for bone loss and vascular calcifications.

Vertebral fractures and abdominal aortic calcification in postmenopausal women. A cohort study

INTRODUCTION

Vertebral fracture assessment (VFA) imaging with a bone densitometer can simultaneously detect prevalent vertebral fractures (VFs) and abdominal aortic calcification (AAC).

OBJECTIVE

To study the relation between the prevalence of VFs using VFA in asymptomatic women and the prevalence and severity of AAC.

DESIGN

This is a cross-sectional study.

SETTINGS

Subjects were recruited in a third care center from asymptomatic women selected from the general population.

PARTICIPANTS

We enrolled 908 post-menopausal women with a mean age of 60.9 years ± 7.7 (50 to 91) with no prior known diagnosis of osteoporosis or taking medication interfering with bone metabolism.

PRIMARY AND SECONDARY OUTCOME MEASURES

Lateral VFA images and scans of the lumbar spine and proximal femur were obtained using a GE Healthcare Lunar Prodigy densitometer. VFs were defined using a combination of Genant semiquantitative (SQ) approach and morphometry. VFA images were scored for AAC using a validated 24 point scale.

RESULTS

VFA images showed that 179 of the participants (19.7%) had at least one grade 2/3 VF, 81% did not have any detectable AAC whereas the prevalence of significant atherosclerotic burden, defined as AAC score of 5 or higher, was 12%. The group of women with 2/3 VFs had a statistically significant higher AAC score and higher proportion of subjects with extended AAC, and lower weight, height, and lumbar spine and hip BMD and T-scores than those without VFA-identified VFs. Multiple regression analysis showed that the presence of grade 2/3 VFs was significantly associated with age, BMI, history of peripheral fracture, AAC score ≥ 5 and densitometric osteoporosis.

CONCLUSION

In post-menopausal women, extended AAC is independently associated with prevalent VFs regardless of age, BMI, history of fractures, and BMD.

Severity of aortic calcification is positively associated with vertebral fracture in older men--a densitometry study in the STRAMBO cohort

In older men, severe abdominal aortic calcification and vertebral fracture (both assessed using dual-energy X-ray absorptiometry) were positively associated after adjustment for confounders including bone mineral density.

INTRODUCTION

Abdominal aortic calcification (AAC) is associated with higher fracture risk, independently of low bone mineral density (BMD). Dual-energy X-ray absorptiometry (DXA) can be used to assess both vertebral fracture and AAC and requires less time, cost, and radiation exposure.

METHODS

We conducted a cross-sectional study of the association between AAC and prevalent vertebral fractures in 901 men≥50 years old. We used DXA (vertebral fracture assessment) to evaluate BMD, vertebral fracture, and AAC.

RESULTS

Prevalence of vertebral fracture was 11%. Median AAC score was 1 and 12% of men had AAC score>6. After adjustment for age, weight, femoral neck BMD, smoking, ischemic heart disease, diabetes, and hypertension, AAC score>6 (vs ≤6) was associated with 2.5 (95% CI, 1.4-4.5) higher odds of vertebral fracture. Odds of vertebral fracture for AAC score>6 increased with vertebral fracture severity (grade 1, OR=1.8; grade 2, OR=2.4; grade 3, OR=4.4; trend p<0.01) and with the number of vertebral fractures (1 fracture, OR=2.0, >1 fracture, OR=3.5). Prevalence of vertebral fracture was twice as high in men having both a T-score<-2.0 and an AAC score>6 compared with men having only one of these characteristics.

CONCLUSIONS

Men with greater severity AAC had greater severity and greater number of vertebral fractures, independently of BMD and co-morbidities. DXA can be used to assess vertebral fracture and AAC. It can provide a rapid, safe, and less expensive alternative to radiography. DXA may be an important clinical tool to identify men at high risk of adverse outcomes from osteoporosis and cardiovascular disease.

Association between cardiovascular diseases and osteoporosis-reappraisal

Positive association between cardiovascular diseases and osteoporosis is important because it concerns two major public health problems. Men and women with cardiovascular diseases (including severe abdominal aortic calcification (AAC) and peripheral arterial disease) tend to have lower areal and volumetric bone mineral density (BMD) as well as faster bone loss, although findings vary according to skeletal site. On one hand, severe forms of cardiovascular diseases (heart failure, myocardial infarction, hypertension, severe AAC) are associated with higher risk of osteoporotic fracture, especially hip fracture. This link was found in the studies based on healthcare databases and the cohort studies. On the other hand, low BMD, history of fragility fracture, vitamin D deficit and increased bone resorption are associated with higher risk of major cardiovascular events (myocardial infraction, stroke, cardiovascular mortality). Moreover, osteocalcin secreted by osteoblasts may be involved in the regulation of energetic and cardiovascular metabolism. The association between both pathologies depends partially on the shared risk factors, and also on the mechanisms that are involved in the regulation of bone and cardiovascular metabolism. Interpretation of the data should take into account methodological limitations: representativeness of the cohorts, quality of the registers and the information obtained from questionnaires, severity of diseases, number of events (statistical power) and their temporal closeness, availability of the information on potential confounders. It seems that patients with severe form of osteoporosis would benefit from assessment of the cardiovascular status and vice versa. However, official guidelines for the clinical practice are still lacking.