Association between Lumbar Bone Mineral Density and Carotid Intima-Media Thickness in Korean Adults: a Cross-sectional Study of Healthy Twin Study

The relationship of bone mineral density with the of the intima-media thickness in premenopausal women

Background: Osteoporosis and cardiovascular disease (CVD) are among the most common causes of morbidity, disability and death worldwide. In recent years, more and more data have been accumulating on the presence of an age-independent relationship and general pathogenetic mechanisms of a decrease in bone mineral density (BMD) and the development of CVD. It has been shown that a decrease in BMD is an important independent predictor of the risk of atherosclerosis of the great arteries and is associated with increased calcification of the aorta and other vessels. The strongest relationship between these parameters was observed in the study of the female population, in connection with which we selected a group of middle-aged women for analysis.

Objective: to investigate the association between bone mineral density and carotid intima-media thickness in middle-aged women.

Results: 35 women were included in the study. The mean age was 44,74±4,32 years. We found the following changes in arterial wall characteristics: atherosclerosis — 21,9% women, increased carotid intima thickness — 15,7% women. Low bone mineral density for chronological age (Z-criteria -2,0 and less) was found in 7 patients at the age of 35±2,7 years. We discovered a negative correlation between the markers of subclinical atherosclerosis and bone mass: Ccarotid intimamedia thickness negatively correlated with bone mineral density in hip (p<0,05), and presence of atherosclerosis plaques was associated with lower bone mineral density in the proximal part of hip (p<0,05).

Conclusion: The findings about negative association between bone mineral density of hip with preclinical markers of atherosclerosis allow us to make a conclusion about their interaction.

Early vascular ageing biomarkers in osteoporotic outpatients: a pilot study

Osteoporosis and atherosclerosis are significant public health problems that often coexist, especially in the elderly. Although some studies have reported an age-dependent relationship, others have suggested a causal relationship between osteoporosis and atherosclerosis. The aim of our study was to evaluate the cardiovascular risk in a population of patients with osteoporosis by measuring carotid intima-media thickness (cIMT) and carotid-femoral pulse wave velocity (cf-PWV). A total of 58 patients with osteoporosis and an equal number of healthy control subjects were enrolled. All subjects underwent (1) a bone densitometry examination using dual X-ray absorptiometry, (2) a vascular evaluation for the measurements of cIMT and cf-PWV and (3) a blood sample for the evaluation of lipids and phosphocalcic metabolism. Patients with osteoporosis had a significant increase in cIMT and cf-PWV. There was also a significant inverse correlation between the femoral neck BMD and cf-PWV values. In conclusion, osteoporotic outpatients have earlier vascular ageing, with an increase of arterial stiffness. These data support a possible association between osteoporosis and atherosclerosis independent of age.

Carotid plaque and lumbar bone mineral density status in post-menopausal women: An age-matched, analytical cross-sectional study

Objective

To explore the association between carotid plaque and lumbar spine osteoporosis in post-menopausal women.

Study design

Age-matched, cross-sectional study.

Main outcome measures

Carotid plaque and carotid intima media thickness were measured with B-mode ultrasound. Lumbar spine bone mineral density was measured with dual-energy X-ray absorptiometry. Prevalence odds ratios and the respective 95% confidence intervals (95%CI) were calculated to determine the association.

Results

Seventy-two post-menopausal women with lumbar spine osteoporosis and 72 post-menopausal women with normal lumbar spine bone mineral density were enrolled. The adjusted prevalence odds ratio of carotid plaque presence in post-menopausal women with lumbar spine osteoporosis was 1.73 (95%CI; 0.60 to 4.94) when compared to post-menopausal women with normal lumbar spine bone mineral density. The presence of vulnerable plaque was greater in post-menopausal women with lumbar spine osteoporosis; however, the difference was not statistically significant after adjusting for other risk factors of cardiovascular disease (odds ratio 1.31; 95%CI; 0.39 to 4.43). There was no significant difference in carotid intima media thickness between the two groups. Multiple logistic regression analysis with backward elimination in assessment of potential risk factors for the presence of carotid plaque showed that the year since menopause, family history of cardiovascular disease and systolic blood pressure were nominally significant associated factors with a respective adjusted odds ratio of 1.06 (95%CI; 1.01 to 1.12), 6.23 (95%CI; 1.65 to 23.46) and 1.03 (95%CI; 1.01 to 1.06).

Conclusions

The current study indicates that lumbar spine osteoporosis is not associated with the presence of carotid plaque, whereas year since menopause, family history of cardiovascular disease and systolic blood pressure are associated factors.

Body mass index and glucocorticoid dose contribute to subclinical atherosclerosis in Korean patients with systemic lupus erythematosus: A prospective 4 year follow-up study

AIM

Patients with systemic lupus erythematosus (SLE) have an increased risk of cardiovascular disease owing to an immunological abnormality, along with traditional risk factors. We found that carotid artery intima-media thickness (cIMT) and plaque were associated with age, body mass index (BMI) and disease activity in a previous study 4 years ago. Our aim was to identify risk factors associated with progression of subclinical atherosclerosis in SLE.

METHODS

We assessed cIMT and plaque using Doppler ultrasonography in 61 Korean women with SLE who were enrolled in the previous study 4 years ago.

RESULTS

The mean cIMT of the patients was 0.39 ± 0.09 mm; 11 patients had carotid plaques, which was similar to the results of the previous study. Twenty-one patients had increased cIMT, and new carotid plaque had developed in seven patients. Patients with increased cIMT had a lower BMI and took fewer non-steroidal anti-inflammatory drugs and higher 4 year cumulative glucocorticoid dose than patients without increased cIMT. The 4 year cumulative glucocorticoid dose was higher in patients with carotid plaque than in those without. On multivariate regression analysis, BMI (odds ratio [OR] = 0.67, P = 0.034) was associated with increased cIMT, and the 4 year cumulative glucocorticoid dose was associated with increased cIMT (OR = 6.994, P = 0.025) and carotid plaque (OR = 5.651, P = 0.031).

CONCLUSION

This prospective follow-up study on cIMT and plaque in patients with SLE showed that low BMI and 4 year cumulative glucocorticoid dose were associated with the progression of subclinical atherosclerosis.

Osteoporosis is inversely associated with arterial stiffness in the elderly: An investigation using the Osteoporosis Self-assessment Tool for Asians index in an elderly Chinese cohort

Although the association of arterial stiffness and osteoporosis has been reported, the relation of arterial stiffness with risk of osteoporosis and bone fracture is not established. The authors investigated the correlation between arterial stiffness (brachial-ankle pulse wave velocity [baPWV]), including a cutoff value, and risk of osteoporosis as assessed by the Osteoporosis Self-assessment Tool for Asia (OSTA) index in 129 elderly Chinese community-dwelling individuals (age 83.2 ± 12.8 years, 63 females). OSTA was negatively correlated with baPWV (r = -0.326, P = 0.023) after adjusting for confounding factors such as gender, body mass index, low-density lipoprotein, triglycerides, estimated glomerular filtration rate, absence or presence of diabetes, absence or presence of hypertension, and uric acid. baPWV was an independent factor for changes in OSTA (β = -0.001, P = 0.002). ROC curve analysis confirmed association between baPWV and OSTA index (AUC = 0.742 [CI: 0.660, 0.824]; P < 0.001) with a baPWV cutoff value of 1676 cm/s (sensitivity, 80.7%; specificity, 60%) for prediction of high OSTA index. The study showed a significant correlation between OSTA index and baPWV, suggesting a potential predictive value of baPWV in elderly patient at high risk of osteoporosis.

Low Bone Mineral Density Is Not Associated with Subclinical Atherosclerosis: A Population-Based Study in Rural China

OBJECTIVES

Loss of bone mass may affect the progression of atherosclerosis. We investigated the relationship between low bone mineral density (BMD) and subclinical atherosclerosis in rural China.

METHODS

In total, 333 men and 421 postmenopausal women aged 55-65 years were enrolled. BMD was measured in the lumbar spine, femoral neck, and total hip using dual-energy X-ray absorptiometry. Subclinical atherosclerosis was defined as increased carotid artery intima-media thickness (CIMT ≥0.9 mm), the presence of carotid plaques, high brachial-ankle pulse wave velocity (baPWV ≥1,400 cm/s), and low ankle-brachial index (ABI ≤1). Binary logistic regression analyses were used to estimate the association between low BMD and subclinical atherosclerosis.

RESULTS

There was no significant difference in BMD between the normal group and the subclinical atherosclerosis group. After full adjustment for the relevant covariates, a boundary significant association was found between low BMD in the femoral neck and baPWV in postmenopausal women (odds ratio = 1.77, p = 0.049). After full adjustment, neither BMD nor low BMD were significantly associated with subclinical atherosclerosis in men or postmenopausal women.

CONCLUSIONS

Low BMD is not associated with subclinical atherosclerosis in Chinese individuals aged 55-65 years resident in rural China.

The associations of subclinical atherosclerotic cardiovascular disease with hip fracture risk and bone mineral density in elderly adults

In the absence of clinically recognized cardiovascular disease, increased carotid artery intimal medial thickness was associated with higher hip fracture risk in older adults, despite its association with higher bone mineral density (BMD). Low ankle brachial index and aortic wall thickness were not associated with fracture risk or BMD.

INTRODUCTION

Clinically recognized cardiovascular disease (CVD) is associated with osteoporosis and hip fracture risk, but the relationship of subclinical atherosclerosis to bone health is not certain.

METHODS

We followed 3385 participants from the Cardiovascular Health Study (mean age 74.7 ± 5.3 years) with a median time to fracture of 12.1 years who underwent baseline carotid artery and aortic wall ultrasound scanning and ankle brachial blood pressure index (ABI) determinations. A subset underwent bone mineral density (BMD) testing.

RESULTS

There were 494 hip fractures during follow-up. Among persons without clinical CVD, an average standard-deviation increase in a composite score of maximal common and internal carotid artery intimal medial thickness (cIMT) was associated with increased risk of hip fracture [(HR 1.18 [1.04, 1.35]), even though cIMT was positively associated with BMD. Neither aortic wall thickness nor ABI were associated with hip fracture risk or BMD. Among participants with clinical CVD, cIMT and aortic wall thickness, but not ABI, were associated with increased hip fracture risk.

CONCLUSION

Subclinical cIMT is associated with an increased risk of hip fractures despite being associated with increased BMD. This finding suggests that vascular health, even in its early stages, is linked to bone health, by pathways other than BMD.