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

Abstract

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 increased 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.

Predictors of Imminent Risk of Nonvertebral Fracture in Older, High‐Risk Women: The Framingham Osteoporosis Study

“…This could be because of the disease for which they were prescribed (CVD) or because of the hypotensive effects of taking nitrates. Because persons with CVD manifest by aortic calcification, they may also have greater fracture risk . The study from claims data supports the limited medications data from our cohort.…”

“…Because persons with CVD manifest by aortic calcification, they may also have greater fracture risk. (28) The study from claims data supports the limited medications data from our cohort. Attributing risk to medication prescribing may suffer from bias by indication, making it quite difficult to discern the disease from the medication used to treat the disease, as the causal risk factor.…”

Association Between Abdominal Aortic Calcification, Bone Mineral Density, and Fracture in Older Women

“…Furthermore, AAC was associated with fracture, independent of conventional fracture risk factors, suggesting a novel potentially non‐BMD mechanism. A previous nested case‐cohort study in older women ( n = 951, mean age approximately 72 years) found that an AAC24 score >4, assessed from DXA‐derived LSIs, was not associated with a risk of nonvertebral fractures after 4 or 15 years, but was associated with a higher 4‐year risk of vertebral fractures and 5‐year risk of hip fractures . A prospective study of older men ( n = 5400, aged ≥65 years) found severe AAC was associated with a high risk of hip fracture, but not nonhip fractures .…”

“…A previous nested case-cohort study in older women (n = 951, mean age approximately 72 years) found that an AAC24 score >4, assessed from DXA-derived LSIs, was not associated with a risk of nonvertebral fractures after 4 or 15 years, but was associated with a higher 4-year risk of vertebral fractures and 5-year risk of hip fractures. (37) A prospective study of older men (n = 5400, aged ≥65 years) found severe AAC was associated with a high risk of hip fracture, but not nonhip fractures. (36) These discordant differences between the current study and the above-mentioned studies may have been caused by the cut-point selected, the fracture ascertainment methods, or population differences.…”

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

“…Results are reported per one-unit increase in ABI, per increase in one average standard deviation increase of CD, and for 1 mm increase in thickness of both walls of the aorta (AWT). To determine whether the association of subclinical CVD with fracture risk weakened with duration of follow up (22) analyses were repeated with 5 years follow up and 10 years follow up. To put our CD findings into context, we also estimated the risk of clinical CVD outcomes for an increase of one average standard deviation increase of CD.…”