Calcaneal quantitative ultrasound is associated with all-cause and cardiovascular disease mortality independent of hip bone mineral density

Abstract

Osteoporosis has been linked with increased risk of cardiovascular disease previously. However, few studies have detailed bone and vascular information. In a prospective study of older women, we demonstrated heel quantitative ultrasound measures were associated with increased cardiovascular and all-cause mortality, independent of established cardiovascular risk factors. Introduction Osteoporosis and low bone mineral density (BMD) have been previously linked to cardiovascular disease (CVD) and mortality. Calcaneal quantitative ultrasound (QUS) is used to evaluate bone material properties, especially in older women. However, it is uncertain whether it is related to risk of mortality. This study was aimed to investigate the association between calcaneal QUS measurements and 15-year all-cause and CVD mortality in 1404 older women (mean age 75.2 ± 2.7 years). Methods One thousand four hundred four older women, participants of Calcium Intake Fracture Outcome study (CAIFOS), had calcaneal bone measured at baseline (1998) and followed for 15 years. The primary outcomes, any deaths, and deaths attributable to cardiovascular causes ascertained by using linked data were obtained from Western Australia data linkage system. Results Over the 15 years of follow-up (17,955 person years), 584 of the women died, and 223 from CVD. For every standard deviation (SD), reduction in broadband ultrasound attenuation (BUA) in minimally and multivariable-adjusted model including cardiovascular risk factors increased relative hazards for all-cause (multivariable-adjusted HR 1.15; 95%CI: 1.06-1.26, p = 0.001) and CVD mortality (multivariable-adjusted HR 1.20; 95%CI: 1.04-1.38, p = 0.010). Such relationships also persisted when hip BMD was included in the model (all-cause mortality HR 1.19; 95%CI: 1.07-1.33, p = 0.002; CVD mortality HR 1.28; 95%CI: 1.07-1.53, p = 0.008). Conclusion BUA is associated with all-cause and CVD mortality in older women independent of BMD and established CVD risk factors. Understanding why and how these are related may provide further insights about the bone-vascular nexus as well as therapeutic targets benefiting both systems.

Bone Mineral Density is positively associated with risk of All-Cause and Cardiovascular Mortality among Adults with Type 2 Diabetes Mellitus:a cross-sectional study of the NHANES 2005-2010,2013-2014

“…Some previous studies had reported a correlation between BMD or osteoporosis and the risk of all-cause mortality and CVD mortality.Research by Cai S showed that total femur (HR = 1.36, 95% CI = 1.07-1.73), femur neck (HR = 1.41, 95% CI = 1.11-1.78), intertrochanter (HR = 1.34, 95% CI = 1.05-1.72), and entire body (HR = 1.36, 95% CI = 1.09-1.69) osteoporotic participants had a higher risk of all-cause mortality compared with normal participants.However,the statistically signi cant L-shaped relationships were only identi ed for heart disease mortality with BMD increment within certain limits in the femur, whereas the remarkable relationships disappeared after BMD continued to increase [14].Other ndings from nationally representative cohorts also suggested that osteoporosis was associated with an increased risk of all-cause mortality(HR = 1.37, 95% CI = 1.11, 1.68), and this association was stronger in participants who were older and had a lower BMI.Similarly, non-signi cant results were observed for osteoporosis with CVD mortality in their study, the non-signi cant results might be due to the lower number of incident CVD, and cancer deaths, and short-time follow-up [15].Other studies had drawn some positive conclusions on the relationship between osteoporosis and cardiovascular disease risk.Irene's study included a total of 305,072 UK Biobank participants diagnosed with osteoporosis at baseline, the study concluded that men with osteoporosis had a higher mortality risk from CVD(HR = 1.68,95%CI = 1.19-2.37).However, women with osteoporosis only had a higher risk of incident CVD(HR = 1.24,95%CI = 1.97-1.44),and the risk of CVD mortality was not affected [16].Calcaneal quantitative ultrasound (QUS) was utilized to assess bone material properties, particularly in elderly women, and could also be used to diagnose osteoporosis.In a prospective study of aged women, A. K. Gebre found that quantitative ultrasound measurements of the calcaneus were independently associated with increased cardiovascular and all-cause mortality, independent of established cardiovascular risk factors.Reduction in broadband ultrasound attenuation (BUA) in the minimally and multi-variable adjusted model including cardiovascular risk factors increased relative hazard for all-cause mortality (HR = 1.15,95%CI = 1.06-1.261) and CVD mortality (HR = 1.20,95%CI = 1.04-1.38).Nonetheless, this observational study was limited to geriatric females only, and the results were not founded on the analysis of BMD values [17].In a similar study called the AA-DHS, vertebral BMD(vBMD) was analyzed in 675 African American men with T2DM and the results suggested that lower vBMD was associated with increased all-cause mortality, but regrettably, this study also showed that lower vBMD was not linked to other mortality risk factors, including subclinical atherosclerosis [18].…”

The causal relationship between autoimmune diseases and osteoporosis: a study based on Mendelian randomization

“…Osteoporosis is an important risk factor for accidents, disability, and death (51). Therefore, this finding is of great significance to public health.…”

“…Therefore, a larger sample size was used, and a more comprehensive assessment was conducted in this study, which not only proved a negative causal relationship between UC and forearms BMD and body BMD but also found a negative causal relationship between IBD and body BMD at the age of 45–60 years. Osteoporosis is an important risk factor for accidents, disability, and death ( 51 ). Therefore, this finding is of great significance to public health.…”

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

“…The average measurement of broadband ultrasound attenuation, speed of sound, and stiffness index were recorded as detailed. [ 23 ] Total hip and femoral neck BMD of subjects was measured by DXA (Hologic Acclaim 4500A fan‐beam densitometer; Hologic Corp, Waltham, MA, USA). The coefficient of variation at the total hip was 1.2% in our laboratory.…”