High Cardiovascular Risk in Older Men with Poor Bone Microarchitecture—The Prospective STRAMBO Study

Abstract

Data on the association between bone microarchitecture and cardiovascular disease (CVD) in men are scarce. We studied the link of bone microarchitecture and areal bone mineral density (aBMD) with the risk of major adverse coronary event (MACE) in a cohort of men aged 60 to 87 years followed prospectively for 8 years. At baseline, aBMD was measured using a Hologic Discovery‐A device. Bone microarchitecture was assessed at distal radius and tibia by high‐resolution peripheral quantitative computed tomography (XtremeCT Scanco device). During the study, 53 men had incident MACE. The analyses were adjusted for confounders related to bone and CVD. In 813 men (53 MACEs), higher aBMD at the lumbar spine, hip, whole body, and radius was associated with lower risk of MACE (hazard ratio [HR] = 0.44–0.71/SD, p < .025 to < .001). In 745 men having valid distal radius scan (47 MACEs), higher cortical density (Ct.BMD) and higher cortical thickness (Ct.Thd) were associated with lower risk of MACE. This risk was higher in men in the lowest quintile of cortical measures versus the four upper quintiles combined (Ct.BMD: HR = 2.12, 95% confidence interval [CI] 1.08–4.17, p < .025). Findings were similar in 779 men having valid distal tibia scan (48 MACEs). At both sites, higher estimated stiffness and higher failure load were associated with a lower risk of MACE. The risk of MACE was higher in men in the lowest quintile of the measures of bone strength versus four upper quintiles jointly (distal radius stiffness: HR = 2.46, 95% CI 1.27–4.74, p < .01). Similar results were obtained in 638 men without prior fragility fracture and in 689 men without ischemic heart disease at baseline. Thus, in older men followed prospectively for 8 years, higher aBMD, preserved cortical bone status, and higher estimated bone strength were associated with lower risk of MACE after adjustment for relevant confounders. © 2021 American Society for Bone and Mineral Research (ASBMR).

Circulating SIRT1 and Sclerostin Correlates with Bone Status in Young Women with Different Degrees of Adiposity

“…Several studies showed that preserved cortical bone status and strength are associated with a lower risk of major adverse coronary events [ 50 ]. Interestingly, increased levels of sclerostin were found both in serum and bone specimens of patients with type 2 diabetes [ 51 , 52 ], post-menopausal women compared to pre-menopausal ones [ 22 , 53 ], immobilized postmenopausal women with bone resorption markers elevation [ 54 ] and postmenopausal women with osteoporosis compared to postmenopausal women without osteoporosis, even if no correlation was seen with BMD [ 55 ].…”

Elevated lipoprotein(a) as a predictor for coronary events in older men

“…Following informed consent, participants underwent medical exams, with no exclusion criteria applied. Among those included in the original cohort, 825 men older than 60 years were followed up prospectively ( 14 ). Of the 755 participants within the study, 112 reported cardiovascular events prior to recruitment, namely acute myocardial infarction (AMI) and ischemic heart disease (IHD).…”

“…Serum osteoprotegerin was measured by ELISA (Biomedica Medizinprodukte GmbH & Co Kg, Vienna, Austria) as described previously ( 16 ). Serum parathyroid hormone was measured using a human-specific two-site immunochemiluminescence assay (ELECSYS; Roche) as described previously ( 14 ). Serum 25-hydroxycholecalciferol was measured with RIA (DiaSorin, Stillwater, MN) after acetonitrile extraction ( 14 ).…”

“…Serum parathyroid hormone was measured using a human-specific two-site immunochemiluminescence assay (ELECSYS; Roche) as described previously ( 14 ). Serum 25-hydroxycholecalciferol was measured with RIA (DiaSorin, Stillwater, MN) after acetonitrile extraction ( 14 ). High-sensitivity C-reactive protein was measured by immunoturbidimetric latex C-reactive protein assay ( 17 ) (Roche Diagnostics, Mannheim, Germany).…”

Bone Mineral Density Is Inversely Associated With Mortality in Chronic Kidney Disease Patients: A Meta-Analysis

“…( 8,9 ) It is generally considered that bone condition as evaluated by BMD in CKD patients may have much greater impacts on major health outcomes, such as vascular calcification and other cardiovascular diseases, compared with the general population. ( 7,10,11 ) In previous studies, low BMD measured by whole‐body DXA was associated with increased risk of fractures and cardiovascular disease mortality in patients with ESRD and/or hemodialysis. ( 12‐15 ) Furthermore, previous cohort study suggested that cortical bone such as arm tended to be more strongly associated with mortality than trabecular bone in CKD patients; however, other studies indicated that BMD at hip and spine may be the optimal sites to reflect bone loss and predict survival in ESRD or hemodialysis patients.…”