High hip fracture risk in men with severe aortic calcification: MrOS study

Abstract

A significant link between cardiovascular disease and osteoporosis is established in postmenopausal women, but data in men are scarce. We tested the hypothesis that greater severity of abdominal aortic calcification (AAC) was associated with an increased risk of non-spine fracture in 5994 men aged ≥65 years. AAC wasassessed on 5400 baseline lateral thoraco-lumbar radiographs using a validated visual semi-quantitative score. Total hip bone mineral density (BMD) was measured using dual energy X-ray absorptiometry. Incident non-spine fractures were centrally adjudicated. After adjustment for age, BMI, total hip BMD, fall history, prior fracture, smoking status, co-morbidities, race and clinical center, the risk of non-spine fracture (n=805) was increased among men with higher AAC (HR Q4 (AAC score ≥9) vs Q1 (0-1): 1.36, 96%CI: 1.10-1.68). This association was due to an increased risk of hip fracture (n=178) among men with higher AAC (HR Q4 vs Q1: 2.33, 95%CI: 1.41-3.87). By contrast, the association between AAC and the risk of non-spine-non-hip fracture was weaker and not significant (HR Q4 vs Q1: 1.22, 95%CI: 0.96-1.55). The findings regarding higher AAC and increased risk of fracture were not altered in additional analyses accounting for degree of trauma, estimated glomerular filtration rate, presence of lumbar vertebral fractures (which may bias AAC assessment), preexisting cardiovascular disease, ankle brachial index or competing risk of death. Thus, in this large cohort of elderly men, greater AAC was independently associated with an increased risk of hip fracture, but not with other non-spine fractures. These findings suggest that AAC assessment may be a useful method for identification of older men at high risk of hip fracture.

Abdominal aortic calcification and risk of fracture among older women — The SOF study

“…fall, trauma (36–37). The association of severe AAC with hip and vertebral fractures was significant after adjustment for BMD similarly to previous data (8–9,33,35) indicating that the link between AAC and fracture risk is not mediated by BMD. Of note, in older subjects, severe AAC was associated with lower trabecular, but not cortical, density at the spine and proximal femur (3,38).…”

“…In 327 postmenopausal women consulted for osteoporosis, presence of AAC was associated with “vertebral or hip fracture” (adjusted for multiple confounders), but not with the wrist fracture or “other fractures” (5). In 5400 elderly men, severe AAC was associated with higher risk of hip fracture, but not with the risk of nonspine nonhip fracture (33). In a cross-sectional study performed in 624 men and women aged 50–89, severe AAC was associated with higher odds of vertebral fracture, but not with the nonspine fracture (34).…”

Vascular calcification and fracture risk

“…It may be speculated that the higher risk of hip fracture in subjects with severe AAC is related to higher risk of fall due to impaired blood flow in lower limbs leading to lower muscle strength and poor balance. However, the association between severe AAC and higher risk of hip fracture remained significant after adjustment for ankle-brachial index (which reflects poor blood flow in the lower half of the body) and after adjustment for gait speed (which is associated with lower strength of muscles of lower limbs) (26). Several common risk factors of severe AAC and fracture risk are possible: age, smoking, hypertension, diabetes mellitus, vitamin D deficit, sex steroid deficit, poor renal function, and low grade systemic inflammation.…”

“…In a cohort of 5400 men aged 65 years and older, severe AAC (>8 on the 24-point scale) was associated with a significantly higher risk of hip fracture, but not with the risk of other non-vertebral fractures (26). Several (11,20,(25)(26)(27), but not all (14) studies showed that severe AAC is associated with low BMD at various skeletal sites after adjustment for age. Mild AAC is not associated with lower BMD.…”

Ischemic heart disease is associated with lower cortical volumetric bone mineral density of distal radius

“…Several studies showed that CVD and vascular calcification are associated with decreased bone mineral density (BMD) and increased bone fractures [9,10]. Indeed, a diagnosis of CVD, either myocardial infarction, heart failure, stroke or peripheral arterial disease, has been shown to be related to the subsequent risk of osteoporotic fracture (mostly hip fracture) [11][12][13][14].…”