Association between low bone mass and aortic valve sclerosis in Koreans

Choi, Han Seok; Rhee, Yumie; Hur, Nam Wook; Chung, Namsik; Lee, Mi Kyung; Lim, Sung Kil

doi:10.1111/j.1365-2265.2009.03543.x

Cited by 8 publications

(8 citation statements)

References 38 publications

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“…In contrast to numerous investigations of bone density and vascular calcification, few studies have investigated associations between bone density and valvular calcification. Small studies, based on referral samples, found an association between lower T ‐score and aortic valve calcification, evaluated by echocardiography examination . These findings are concordant with our results for bone and vascular calcification, however, not with our null findings for bone and valvular calcification.…”

Section: Discussionsupporting

confidence: 87%

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QCT Volumetric Bone Mineral Density and Vascular and Valvular Calcification: The Framingham Study

Chan

Cupples

Kiel

et al. 2015

Journal of Bone and Mineral Research

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There is increasing evidence that bone and vascular calcification share common pathogenesis. Little is known about potential links between bone and valvular calcification. The purpose of this study was to determine the association between spine bone mineral density (BMD) and vascular and valvular calcification. Participants included 1317 participants (689 women, 628 men) in the Framingham Offspring Study (mean age 60 years). Integral, trabecular, and cortical volumetric bone density (vBMD) and arterial and valvular calcification were measured from computed tomography (CT) scans and categorized by sex-specific quartiles (Q4 = high vBMD). Calcification of the coronary arteries (CAC), abdominal aorta (AAC), aortic valve (AVC), and mitral valve (MVC) were quantified using the Agatston Score (AS). Prevalence of any calcium (AS >0) was 69% for CAC, 81% for AAC, 39% for AVC, and 20% for MVC. In women, CAC increased with decreasing quartile of trabecular vBMD: adjusted mean CAC = 2.1 (Q4), 2.2 (Q3), 2.5 (Q2), 2.6 (Q1); trend p = 0.04. However, there was no inverse trend between CAC and trabecular vBMD in men: CAC = 4.3 (Q4), 4.3 (Q3), 4.2 (Q2), 4.3 (Q1); trend p = 0.92. AAC increased with decreasing quartile of trabecular vBMD in both women (AAC = 4.5 [Q4], 4.8 [Q3], 5.4 [Q2], 5.1 [Q1]; trend p = 0.01) and men (AAC = 5.5 [Q4], 5.8 [Q3], 5.9 [Q2], 6.2 [Q1]; trend p = 0.01). We observed no association between trabecular vBMD and AVC or MVC in women or men. Finally, cortical vBMD was unrelated to vascular calcification and valvular calcification in women and men. Women and men with low spine vBMD have greater severity of vascular calcification, particularly at the abdominal aorta. The inverse relation between AAC and spine vBMD in women and men may be attributable to shared etiology and may be an important link on which to focus treatment efforts that can target individuals at high risk of both fracture and cardiovascular events.

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Section: Discussionsupporting

confidence: 87%

“…Growing evidence suggests cardiovascular calcification is inversely associated with BMD independent of age and other clinical risk factors shared by both disorders . Further, there is some evidence to suggest a similar relationship between valvular calcification and BMD …”

Section: Introductionmentioning

confidence: 99%

QCT Volumetric Bone Mineral Density and Vascular and Valvular Calcification: The Framingham Study

Chan

Cupples

Kiel

et al. 2015

Journal of Bone and Mineral Research

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“…Limited data show a weak but significant association between cardiac valve calcification and lower BMD. Lower BMD (Tscore ≤ -1.5) was associated with higher odds of cardiac valve calcification in women, but not in men (39). In 340 women, severe mitral annular calcification was associated with higher prevalence of osteoporosis diagnosed by DXA (40).…”

Section: Vascular Calcification and Fracture Riskmentioning

confidence: 83%

Vascular calcification and fracture risk

Szulc

2015

ccmbm

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SummaryOsteoporosis and cardiovascular diseases are public health problems. Fragility fractures are associated with high risk of cardiovascular event and patients with cardiovascular diseases have higher risk of fracture. Severe abdominal aortic calcification (AAC) is associated with higher cardiovascular mortality and morbidity. Severe AAC is associated with higher risk of fracture. In cross-sectional studies severe AAC was associated with greater prevalence, higher number and greater severity of vertebral fractures after adjustment for confounders including bone mineral density (BMD). Prospective studies confirm the association between baseline AAC severity and prospectively assessed fracture risk in both sexes. Data on the link between AAC and BMD are discordant. Age, smoking, hypertension, diabetes mellitus, and low grade systemic inflammation are possible risk factors of severe AAC and fracture risk. However, in clinical studies, the link between AAC and fracture was significant after adjustment for these factors. Data on the association between calcification in other vascular beds and BMD are limited and discordant.

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“…(15) A separate study of postmenopausal women who underwent DXA scanning and transthoracic echocardiography showed a significant association between osteoporosis of the lumbar spine and MAC after adjustment for age, although relations with AVC were not reported. (16) Two additional studies(17,18) including patients of both sexes found lower BMD by DXA to be associated with higher frequency of AVC after limited adjustment for covariates, one in women only,(18) but assessment of MAC was not included. Nevertheless, another study comparing calcification and inflammatory processes in bone, heart and vasculature with advanced cardiovascular imaging techniques in a predominantly male sample found no correlation between vertebral body BMD and AVC score by CT, but did not examine MAC.…”

Section: Discussionmentioning

confidence: 99%

“…(12–14) Yet the extent to which this applies to calcification of the cardiac fibrous skeleton is less clear. Among clinical referral populations, low BMD and osteoporosis were linked to higher prevalence of mitral annular calcification (MAC)(15,16) and aortic valve calcification (AVC),(17,18) but such analyses adjusted only partially for potential confounders. Two population-based studies focusing primarily on middle-aged adults have yielded mixed results.…”

Section: Introductionmentioning

confidence: 99%

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

Massera

Bartz

et al. 2017

Arch Osteoporos

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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.

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Association between low bone mass and aortic valve sclerosis in Koreans

Abstract: Low bone mass might be independently associated with increased risk of aortic valve sclerosis in women, but not in men. Women with low bone mass should be further evaluated for the presence of aortic valve sclerosis and related cardiovascular diseases.

Cited by 8 publications

References 38 publications

QCT Volumetric Bone Mineral Density and Vascular and Valvular Calcification: The Framingham Study

QCT Volumetric Bone Mineral Density and Vascular and Valvular Calcification: The Framingham Study

Vascular calcification and fracture risk

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

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