Relationship of bone mineral density with valvular and annular calcification in community-dwelling older people: The Cardiovascular Health Study

Abstract

Introduction The process of cardiac calcification bears a resemblance to skeletal bone metabolism and its regulation. Experimental studies suggest that bone mineral density (BMD) and valvular calcification may be reciprocally related, but epidemiologic data are sparse. Methods: We tested the hypothesis that BMD of the total hip and femoral neck measured by dual-energy X-ray absorptiometry (DXA) is inversely associated with prevalence of three echocardiographic measures of cardiac calcification in a cross-sectional analysis of 1,497 older adults from the Cardiovascular Health Study. The adjusted association of BMD with aortic valve calcification (AVC), aortic annular calcification (AAC) and mitral annular calcification (MAC) was assessed with relative risk (RR) regression. Results Mean (SD) age was 76.2 (4.8) years; 58% were women. Cardiac calcification was highly prevalent in women and men: AVC, 59.5% and 71.0%; AAC 45.1% and 46.7%; MAC 42.8% and 39.5%, respectively. After limited and full adjustment for potential confounders, no statistically significant associations were detected between continuous BMD at either site and the three measures of calcification. Assessment of WHO BMD categories revealed a significant association between osteoporosis at the total hip and AVC in men (adjusted RR compared with normal BMD=1.24 [1.01–1.53]). In graded sensitivity analyses, there were apparent inverse associations between femoral neck BMD and AVC with stenosis in men, and femoral neck BMD and moderate/severe MAC in women, but these were not significant. Conclusion These findings support further investigation of the sex-specific relationships between low BMD and cardiac calcification, and whether processes linking the two could be targeted for therapeutic ends.

Association of mineral content outside of bone with coronary artery calcium and 1‐year cardiovascular prognosis in maintenance hemodialysis patients

“…The mechanism of vascular calcification includes mineral composition deposition and crystallization evolving over time and space, which is a sophisticatedly regulated process that involves a complex interplay between promoters and inhibitors of calcification with several similarities to bone ossification . The current study showed an inverse correlation between MCIB (assumed parallel to bone volume or bone mineral density) and the Agatston score, which was in an agreement with the previous studies . Interestingly, MCOB had a stronger correlation than MCIB.…”

Serum Alkaline Phosphatase Level Predicts Cardiac Valve Calcification in Maintenance Hemodialysis Patients

“…Calcium deposition mostly affected the mitral annulus and aortic valve, which can cause valvular regurgitation, stenosis, or both [8,9]. Recently, CVC was increasingly recognized as both cause and marker of morbidity and mortality in patients with ESRD [10,11] and was associated with an increased risk of cardiovascular events [12,13]. However, little is known about the pathogenesis of CVC, and there is no effective medical therapy.…”

<p>Calcification of Cardiac Valves in Metabolic Bone Disease: An Updated Review of Clinical Studies</p>

“…2009 27 50♂ (62.3± 6.9 years) AVC+ 161♂ (52.4± 7.5 years) AVC- 18 ♀ (62.3± 6.9 years) AVC+ 99 ♀ (52.4± 7.5 years) AVC- AVC LS-BMD Hip-BMD DXA Echocardiography ↓ BMD T-score in ♀ AVC+ T-score was independent predictor of AVC+ in ♀ (OR=0.38; 95% CI0.14–1), but not in♂ Celik A. 2010 29 59 RSF subjects (41.5 years) 11 MAC+; 48 MAC- 40 healthy subjects (44.2 years): 1 MAC+ 39 MAC- MAC LS-BMD Hip-BMD DXA Echocardiography ↓BMD T-score in ♀ MAC+ (1.6±1.0 Vs -0.5±1.2; P <0,01) BMD T-score predictive of MAC+ ( P =0.04) Pfister R. 2014 26 15,651 (62.1±9.1 years) of the EPIC Norfolk population study since Jan 1998 to Oct 2000 AS BUA at heel QUS by CUBA device AS defined by ICD-10 code 135 Inverse association between BUA and AS ↑ SD in BUA is associated with ↓ 20% in AS (HR=0.80) Chan J.J. 2015 37 619 ♀ and 628♂ (60 years) of the Framingham Offspring Study since 2002 to 2005 AVC MVC AAC CAC vBMD of L3 CT Agastone Score by CT No association between vBMD and AVC+ or MAC+ vBMD inversely associated with CAC+ and AAC+ in ♀ but not in ♂ Messera D. 2017 38 868 ♀ and 629♂ (76.2 ± 4.8 years) of the Cardiovascular Health Study AVC MAC Hip-BMD DXA Echocardiography No association between BMD and AVC+ or MAC+ in ♀ or in ♂ Inverse association between Hip-BMD and AVC+ (RR=1.24; 95% CI 1.01–1.56) in ♂ Borderline association Hip-BMD and MAC+ in ♀ Abbreviations: ♀, female; ♂, male; AVC, aortic valve calcification; BMD, bone mineral density; LS-BMD, BMD at lumbar sp...…”

“…Moreover, the study by Messera et al, 38 carried out on 1497 elderly patients from the CHS (Cardiovascular Health Study), showed that there were no significant associations between BMD and the presence of any valvular calcification (aortic and/or mitral valve). However, aortic calcification was greater in male patients with osteoporosis at total femur after adjusting for various confounding factors.…”

“…Conversely, in women there was a correlation (although not statistically significant) between calcification of the mitral valve and the decrease in BMD at the femur. 38 …”