Abdominal aortic calcification on lateral spine images captured during bone density testing and late-life dementia risk in older women: A prospective cohort study

Porter, Tenielle; Sim, Marc; Prince, Richard; Schousboe, John T.; Bondonno, Catherine P.; Lim, Wai H.; Zhu, Kun; Kiel, Douglas P.; Hodgson, Jonathan M.; Laws, Simon M.; Lewis, Joshua R.

doi:10.1016/j.lanwpc.2022.100502

Cited by 9 publications

(10 citation statements)

References 63 publications

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“…Given bone density scans involve a very low radiation dose and are routinely used for osteoporosis screening, performed most commonly in older women, the ability of this ML approach to provide AAC readings at the time of bone density testing is of clear clinical value, especially in the context of opportunistic health screening for other health outcomes including all-cause mortality and cardiovascular events, [6] as well as late-life dementia hospitalizations and deaths. [25] Strengths of the present study include the large number of older Australian women included, who are representative of the population typically undergoing bone densitometry for osteoporosis screening, the long-term prospective followup (10 and 14.5 years for fracture and falls outcomes, respectively), the capture of clinical fracture events through verified self-report (by General Practitioner), as well as the capture of fall-and fracture-related hospitalizations from the Western Australian Data Linkage System independent of self-report. There are also several limitations that should be considered.…”

Section: Discussionmentioning

confidence: 99%

“…We and others have shown that the presence and extent of manually assessed AAC is associated with impaired musculoskeletal health, [ 7,8,11 ] increased risk for all‐cause mortality and cardiac events, [ 6 ] as well as late‐life dementia hospitalizations and deaths. [ 25 ] Recently, we reported that women with higher ML‐AAC24 had increased risk of all‐cause mortality and CVD‐related mortality. [ 13 ] The present study builds on this evidence, demonstrating that higher ML‐AAC24 is also associated with increased incident falls and clinical fracture risk.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Machine-Learning Assessed Abdominal Aortic Calcification is Associated with Long-Term Fall and Fracture Risk in Community-Dwelling Older Australian Women

Dalla Via,

Gebre,

Smith

et al. 2023

Journal of Bone and Mineral Research

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Abdominal aortic calcification (AAC), a recognized measure of advanced vascular disease, is associated with higher cardiovascular risk and poorer long‐term prognosis. AAC can be assessed on dual‐energy X‐ray absorptiometry (DXA)‐derived lateral spine images used for vertebral fracture assessment at the time of bone density screening using a validated 24‐point scoring method (AAC‐24). Previous studies have identified robust associations between AAC‐24 score, incident falls and fractures. However, a major limitation of manual AAC assessment is that it requires a trained expert. Hence, we have developed an automated machine‐learning algorithm for assessing AAC‐24 scores (ML‐AAC24). In this prospective study, we evaluated the association between ML‐AAC24 and long‐term incident falls and fractures in 1,023 community‐dwelling older women (mean age, 75 ± 3 years) from the Perth Longitudinal Study of Ageing Women. Over 10 years of follow‐up, 253 (24.7%) women experienced a clinical fracture identified via self‐report every 4–6 months and verified by X‐ray, and 169 (16.5%) women had a fracture hospitalization identified from linked hospital discharge data. Over 14.5 years, 393 (38.4%) women experienced an injurious fall requiring hospitalization identified from linked hospital discharge data. After adjusting for baseline fracture risk, women with moderate to extensive AAC (ML‐AAC24 ≥ 2) had a greater risk of clinical fractures (HR 1.42, 95%CI 1.10–1.85) and fall‐related hospitalization (HR 1.35, 95%CI 1.09–1.66), compared to those with low AAC (ML‐AAC24 ≤ 1). Similar to manually assessed AAC‐24, ML‐AAC24 was not associated with fracture hospitalizations. The relative hazard estimates obtained using machine learning were similar to those using manually assessed AAC‐24 scores. In conclusion, this novel automated method for assessing AAC, that can be easily and seamlessly captured at the time of bone density testing, has robust associations with long‐term incident clinical fractures and injurious falls. However, the performance of the ML‐AAC24 algorithm needs to be verified in independent cohorts.This article is protected by copyright. All rights reserved.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Machine-Learning Assessed Abdominal Aortic Calcification is Associated with Long-Term Fall and Fracture Risk in Community-Dwelling Older Australian Women

Dalla Via,

Gebre,

Smith

et al. 2023

Journal of Bone and Mineral Research

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“…In the context of CVD, a major contributor to vascular damage to white matter in the brain, 27 the presence (and severity) of carotid plaques 28 and calcification of the abdominal aorta 29 has also been associated with poorer grip strength, the latter reported as a risk factor for late-life dementia. 30 Table 4 Multivariable-adjusted hazard ratios (95% CI) for late-life dementia outcomes over 9.5 years presented by quartiles of change in grip strength or timed-up-and-go (TUG) over 5 years (1998)(1999)(2000)(2001)(2002)(2003) We also observed that women with the slowest TUG (Q4, 12.4 s) had twofold to threefold higher relative hazard for a late-life dementia-related event, hospitalization and/or death, compared with those with the fastest TUG performance (Q1, 7.4 s). Most importantly, we report that women with the greatest decrement in TUG performance over 5 years recorded between 2.5 and 4.1 times greater risk for a late-life dementia event or death.…”

Section: Discussionmentioning

confidence: 99%

“…Data from over 40 000 people aged 40–70 years from the UK Biobank 25 point to a potential role of brain regions vulnerable to neuropathology in AD, 26 with volume of subcortical, hippocampal regions and temporal cortices associated with grip strength. In the context of CVD, a major contributor to vascular damage to white matter in the brain, 27 the presence (and severity) of carotid plaques 28 and calcification of the abdominal aorta 29 has also been associated with poorer grip strength, the latter reported as a risk factor for late‐life dementia 30 …”

Section: Discussionmentioning

confidence: 99%

Impaired muscle function, including its decline, is related to greater long‐term late‐life dementia risk in older women

Radavelli-Bagatini

Macpherson

Scott

et al. 2023

J cachexia sarcopenia muscle

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Background Impaired muscle function has been identified as a risk factor for declining cognitive function and cardiovascular health, both of which are risk factors for late-life dementia (after 80 years of age). We examined whether hand grip strength and timed-up-and-go (TUG) performance, including their change over 5 years, were associated with late-life dementia events in older women and whether any associations provided independent information to Apolipoprotein E ε 4 (APOE ε 4) genotype. Methods Grip strength and TUG were assessed in community-dwelling older women (mean ± SD; age 75.0 ± 2.6 years) at baseline (n = 1225) and 5 years (n = 1052). Incident 14.5-year late-life dementia events (dementia-related hospitalization/death) were obtained from linked health records. Cardiovascular risk factors (Framingham Risk Score), APOE genotyping, prevalent atherosclerotic vascular disease and cardiovascular-related medications were evaluated at baseline. These were included in multivariable-adjusted Cox-proportional hazards models assessing the relationship between muscle function measures and late-life-dementia events. Results Over follow-up, 207 (16.9%) women had a late-life dementia event. Compared with women with the highest grip strength (Quartile [Q] 4, 25.8 kg), those with the lowest grip strength (Q1, 16.0 kg) had greater hazard for a late-life dementia event (HR 2.27 95% CI 1.54-3.35, P < 0.001). For TUG, the slowest women (Q4, 12.4 vs. Q1, 7.4 s) also recorded a greater hazard for a late-life dementia event (HR 2.10 95% CI 1.42-3.10, P = 002). Weak hand grip (<22 kg) or slow TUG (>10.2 s) provided independent information to the presence of an APOE ε 4 allele (n = 280, 22.9%). Compared with women with no weakness and no APOE ε 4 allele, those with weakness and APOE ε 4 allele had a greater hazard (HR 3.19 95% CI 2.09-4.88, P < 0.001) for a late-life dementia event. Women presenting with slowness and the APOE ε 4 allele also recorded a greater hazard for a late-life dementia event (HR 2.59 95% CI 1.64-4.09, P < 0.001). For 5-year muscle function changes, compared with women with the lowest performance decrement (Q1), those with the largest decrement (Q4) had higher hazards for a late-life dementia event (grip strength HR 1.94 95% CI 1.22-3.08, P = 0.006; TUG HR 2.52 95% CI 1.59-3.98, P < 0.001) over the next 9.5 years. Conclusions Weaker grip strength and slower TUG, and a greater decline over 5 years, were significant risk factors for a late-life-dementia event in community-dwelling older women, independent of lifestyle and genetic risk factors. Incorporating muscle function measures as part of dementia screening appears useful to identify high-risk individuals who might benefit from primary prevention programmes.

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Extracolonic Findings, Their Clinical Significance, and the Role of Opportunistic Screening

Bortz

2023

CT Colonography for Radiographers

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Abdominal aortic calcification on lateral spine images captured during bone density testing and late-life dementia risk in older women: A prospective cohort study

Cited by 9 publications

References 63 publications

Machine-Learning Assessed Abdominal Aortic Calcification is Associated with Long-Term Fall and Fracture Risk in Community-Dwelling Older Australian Women

Machine-Learning Assessed Abdominal Aortic Calcification is Associated with Long-Term Fall and Fracture Risk in Community-Dwelling Older Australian Women

Impaired muscle function, including its decline, is related to greater long‐term late‐life dementia risk in older women

Extracolonic Findings, Their Clinical Significance, and the Role of Opportunistic Screening

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