Aortic calcification and the risk of osteoporosis and fractures

Abstract

patients with signs of vascular injury had injury confirmed by angiography. Using angiography as the gold standard in the 59 patients, the overall sensitivity of physical examination to detect vascular injury in stable patients with gunshot wounds to the neck was 57%. Specificity was 53%, with positive and negative predictive values of 43% and 66%.Comment: In recent years, there has been a trend towards more conservative use of catheter-based angiography in patients with possible vascular injury. This trend has been most marked in the evaluation of patients with posterior knee dislocation and in the evaluation of stable patients with penetrating trauma to an extremity. The current data, however, suggest that hemodynamically stable patients with gunshot wounds to the neck should still undergo routine imaging evaluation. In some centers, this may be duplex scanning or computed tomography angiography rather than a catheter-based angiogram.

Is vascular calcification associated with bone mineral density and osteoporotic fractures in ambulatory, elderly women?

“…The inclusion of a subjects referred for computerized tomography (CT) examination may introduce a selection bias, since subjects with a greater prevalence of both osteoporosis and atherosclerosis may been overrepresented, relative to the general population. This hypothesis is supported by the high prevalence of subjects with vascular calcification (76%) or osteoporosis (70%) in the study of Schulz et al [6]. However, CT may measure vascular calcification of the abdominal aorta more accurately than the radiographic method used in our present study.…”

“…This is similar to what was observed in the Framingham study in USA, in which the presence and severity of calcification of the aorta did not link to an increase of the risk of hip fracture in men and women [13]. Our results do not agree with those of Schulz et al who concluded that aortic calcification is a strong predictor of low bone density and fragility fractures [6]. Several methodological differences may account for these discordant results.…”

“…Longitudinal analysis of bone loss and vascular calcification over a 25-year period in the Framingham Heart Study demonstrated that cortical bone loss measured at the metacarpal was associated with the progression of atherosclerotic aortic calcification in women [5]. This study marked the start of a series of publications indicating that aortic calcification may represent a strong predictor of low bone density and an increased risk of fracture [6][7][8]. However, the results of clinical studies of the relationship between bone fragility and vascular calcification have been inconsistent.…”

Risk factors for peripheral fractures vary by age in older men—the prospective MINOS study

“…Smaller bone width was associated with higher risk of fracture regardless of BMD both in men (MINOS cohort) and in women (OFELY cohort) [12,13]. Also in the MINOS cohort, extended calcifications in the abdominal aorta were indicators of the fracture risk in men, even after adjustment for age, body mass index (BMI), BMD, and other confounders [14]. In women, abdominal aortic calcifications were also associated with BMD and fractures [15,16].…”

“…Individual level-specific severity scores for both the posterior and anterior walls (0-3) were added to yield abdominal aortic calcification score (ACS) ranging from 0 to 24. We used ACS as dichotomous variable: 0-6 vs. >6, because this threshold proved to be most discriminative in the previous analysis [14].…”