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

Abstract

Although a relationship between vascular disease and osteoporosis has been recognized, its clinical importance for fracture risk evaluation remains uncertain. Abdominal aortic calcification (AAC), a recognized measure of vascular disease detected on single‐energy images performed for vertebral fracture assessment, may also identify increased osteoporosis risk. In a prospective 10‐year study of 1024 older predominantly white women (mean age 75.0 ± 2.6 years) from the Perth Longitudinal Study of Aging cohort, we evaluated the association between AAC, skeletal structure, and fractures. AAC and spine fracture were assessed at the time of hip densitometry and heel quantitative ultrasound. AAC was scored 0 to 24 (AAC24) and categorized into low AAC (score 0 and 1, n = 459), moderate AAC (score 2 to 5, n = 373), and severe AAC (score >6, n = 192). Prevalent vertebral fractures were calculated using the Genant semiquantitative method. AAC24 scores were inversely related to hip BMD ( r s = –0.077, p = 0.013), heel broadband ultrasound attenuation ( r s = –0.074, p = 0.020), and the Stiffness Index ( r s = –0.073, p = 0.022). In cross‐sectional analyses, women with moderate to severe AAC were more likely to have prevalent fracture and lumbar spine imaging‐detected lumbar spine fractures, but not thoracic spine fractures (Mantel‐Haenszel test of trend p < 0.05). For 10‐year incident clinical fractures and fracture‐related hospitalizations, women with moderate to severe AAC (AAC24 score >1) had increased fracture risk (HR 1.48; 95% CI, 1.15 to 1.91; p = 0.002; HR 1.46; 95% CI, 1.07 to 1.99; p = 0.019, respectively) compared with women with low AAC. This relationship remained significant after adjusting for age and hip BMD for clinical fractures (HR 1.40; 95% CI, 1.08 to 1.81; p = 0.010), but was attenuated for fracture‐related hospitalizations (HR 1.33; 95% CI, 0.98 to 1.83; p = 0.073). In conclusion, older women with more marked AAC are at higher risk of fracture, not completely captured by bone structural predictors. These findings further support the concept that vascular calcification and bone pathology may share similar mechanisms of causation that remain to be fully elucidated © 2019 American Society for Bone and Mineral Research

Joint Associations of Prevalent Radiographic Vertebral Fracture and Abdominal Aortic Calcification With Incident Hip, Major Osteoporotic, and Clinical Vertebral Fractures

“…Our results are complementary to and extend the results of Lewis and colleagues, ( 15 ) who estimated the joint associations of prevalent vertebral fracture and AAC on lateral spine densitometric images with risks of incident clinical fractures and fracture‐related hospitalizations among women aged 70 years and older enrolled in the Calcium Intake Fracture Outcomes Study (CAIFOS). Unlike our study of older men, the interaction term between prevalent vertebral fracture and AAC‐24 score level was significant, indicating the association of AAC with incident clinical fracture was stronger if prevalent vertebral fracture was also present.…”

“…Only one investigation, conducted in a cohort of women aged 70 years and older, thus far has examined the joint prediction of incident fractures from ascertainment of both prevalent vertebral fracture and AAC. ( 15 ) This study found that prevalent vertebral fracture and AAC were both associated with incident clinical fracture adjusted for each other and for other traditional risk factors.…”

The Genetic Architecture of High Bone Mass

“…The relationship between vascular calcification and low BMD is of particular interest (98), most evident (though not exclusively) in the chronic kidney disease population. Abdominal aortic calcification is associated with lower BMD and vertebral fractures (99); and the extent to which genetic pleiotropy underpins vascular calcification [itself heritable (44)] and osteoporosis is the source of active investigation. There are also monogenic forms of vascular calcification (for example, pathogenic variants in ABCC8 causing pseudoxanthoma elasticum (MIM264800) [45][46][47]].…”

Ascending Aortic Calcification as a Potential Predictor for Low Bone Mineral Density: A Pilot Study

“…Vascular calcification is linked to osteoporosis and low BMD in older people or type 2 diabetes patients [ 9 , 10 ]. Older women with more marked abdominal aortic calcification (AAC) are at a higher risk of fracture [ 11 ]. From the point of basic science, arterial calcification processes share some pathways in common with bone physiology, particularly osteoporosis [ 12 ].…”