Volumetric BMD and Vascular Calcification in Middle-Aged Women: The Study of Women's Health Across the Nation

Abstract

The association of spine vBMD with AC and CAC was studied in a biracial cohort of 490 middle-aged women in the Study of Women's Health Across the Nation. Lower vBMD was related to high AC, but not to CAC, independent of age and shared risk factors between osteoporosis and cardiovascular disease.Introduction: This analysis studied the association of spine volumetric BMD (vBMD) with aortic (AC) and coronary artery (CAC) calcification in middle-aged women and evaluated whether such associations were independent of age and shared risk factors between osteoporosis and cardiovascular disease (CVD) or explained by endogenous estradiol levels. Materials and Methods: Vascular calcification and trabecular vBMD of the spine were measured using electron-beam CT in 490 women free from clinical CVD in the Study of Women's Health Across the Nation. Women were 45-58 years of age, 61% were white, and 64% were perimenopausal. Calcification scores were categorized into three levels (no AC, N ‫ס‬ 146; moderate AC, scores ‫ס‬ 1-74, N ‫ס‬ 221; high AC, N ‫ס‬ 123; no CAC, N ‫ס‬ 256; moderate CAC, score ‫ס‬ 1-7.54, N ‫ס‬ 111; high CAC, N ‫ס‬ 123). The highest categories were set at the 75th percentiles. Multinomial logistic regression was used to assess the association between vBMD (per SD) and the AC and CAC levels, with no calcification as the reference group. Results: AC and CAC were detected in 70% and 48% of the population, respectively. Mean vBMD was 161.6 ± 37.2 (SD) mg/ml. vBMD was associated with high AC in unadjusted, age-adjusted, and risk factor-adjusted analysis. Per 1 SD decrease in vBMD, the adjusted odds of high AC compared with no AC was significantly increased by 68% (95% CI, 1.06-2.68). Estradiol did not influence this association. vBMD was related to high CAC in unadjusted (OR ‫ס‬ 1.35; 95% CI, 1.08-1.70) but not adjusted models. No associations of vBMD with moderate AC or CAC were observed. Conclusion: Lower vBMD was related to high AC, but not to CAC, in a biracial cohort of healthy middle-aged women independent of age and shared risk factors between osteoporosis and CVD. Further research should study possible pathophysiological links between the two conditions and the potential for common preventive and therapeutic interventions.

Stones, Bones, and Cardiovascular Groans

“…Second, it is unclear whether the greater severity of abdominal aortic calcification in stone formers was independent of differences in bone mineral density between stone formers and controls. Rather than showing a unique feature of nephrolithiasis, these data, instead, may recapitulate the results of previous studies in nonstone formers showing associations between greater vascular calcification and lower bone mineral density (28,29). Unfortunately, Shavit et al (17) did not include bone mineral density as a covariate in multivariable regression models to see if the positive association between vascular calcification and stone-forming status was attenuated.…”

Effect of Atorvastatin and Etidronate Combination Therapy on Regression of Aortic Atherosclerotic Plaques Evaluated by Magnetic Resonance Imaging

“…At the start of this trial, we thought that it might be problematic to prescribe bisphosphonate to patients without osteoporosis; therefore, we assigned patients with osteoporosis (bone mineral density (BMD) T score 1.5 SD from the normal sex-specific age-adjusted mean) to the ATR ETD group, and patients without osteoporosis to the ATR group. However, after we assigned 45 patients to the two groups, emerging epidemiological studies showed the inverse correlation between BMD and vascular calcification, and suggested the possibility that therapeutic agents with selective increasing effect on BMD could have a regression effect on vascular calcification 19,20) . We thesefore thought it was necessary to assess the benefit of bisphosphonate and statin combination therapy not only for osteoporotic patients but also for non-osteoporotic patients.…”

Decreased bone mineral density is associated with coronary atherosclerosis in healthy postmenopausal women

“…However, other researchers have found that cardiovascular mortality is higher in women with low BMD [6]. Recent studies have also found that atherosclerotic calcification is associated with bone loss in postmenopausal women [17,18], and that a decrease in BMD may be related to subclinical atherosclerosis [7,[19][20][21]. The mechanisms explaining the relationship between osteoporosis and CAD have not yet been elucidated, though it is believed that many other factors may be responsible; these factors have yet to be investigated.…”