The Association between Aortic Calcification and Fracture Risk in Postmenopausal Women in China: The Prospective Chongqing Osteoporosis Study

Zhou, Rui; Zhou, Huadong; Cui, Min; Chen, Lin; Xu, Jianzhong

doi:10.1371/journal.pone.0093882

Cited by 23 publications

(22 citation statements)

References 29 publications

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“…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). Few studies found significant link between severe AAC and overall fracture risk (9,35). These associations were significant only for individuals with severe AAC (>6) and hip fractures comprised a major proportion of the total fracture groups (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…In some, but not all, cross-sectional studies, severe AAC was associated with lower bone mineral density (BMD) and higher odds of vertebral and hip fractures (2–8). In some (8–9), but not all (10–12), prospective studies, severe AAC was associated with higher risk of vertebral and hip fractures.…”

Section: Introductionmentioning

confidence: 99%

“…Studies performed in small samples or in populations with few fracture events may lack statistical power (6–7). Fracture risk may be higher only in individuals with severe AAC (4,9) and a low threshold of AAC severity (e.g. present vs absent) may not be specific enough to observe an association (12).…”

Section: Introductionmentioning

confidence: 99%

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

Szulc

Blackwell

Kiel

et al. 2015

Bone

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Data concerning the link between severity of abdominal aortic calcification (AAC) and fracture risk in postmenopausal women are discordant. This association may vary by skeletal site and duration of follow-up. Our aim was to assess the association between the AAC severity and fracture risk in older women over the short- and long-term. This is a case-cohort study nested in a large multicenter prospective cohort study. The association between AAC and fracture was assessed using Odds Ratios (OR) and 95% confidence intervals (95%CI) for vertebral fractures and using Hazard Risks (HR) and 95%CI for non-vertebral and hip fractures. AAC severity was evaluated from lateral spine radiographs using Kauppila’s semiquantitative score. Severe AAC (AAC score 5+) was associated with higher risk of vertebral fracture during 4 years of follow-up, after adjustment for confounders (age, BMI, walking, smoking, hip bone mineral density, prevalent vertebral fracture, systolic blood pressure, hormone replacement therapy) (OR=2.31, 95%CI: 1.24–4.30, p<0.01). In a similar model, severe AAC was associated with an increased in the hip fracture risk (HR=2.88, 95%CI: 1.00–8.36, p=0.05). AAC was not associated with the risk of any non-vertebral fracture. AAC was not associated with the fracture risk after 15-years of follow-up. In elderly women, severe AAC is associated with higher short-term risk of vertebral and hip fractures, but not with the long-term risk of these fractures. There is no association between AAC and risk of non-vertebral-non-hip fracture in older women. Our findings lend further support to the hypothesis that AAC and skeletal fragility are related.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Szulc

Blackwell

Kiel

et al. 2015

Bone

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“…Mini-review P. Szulc cohort of postmenopausal Chinese women followed up prospectively for 5 years, severe AAC (>6 on the 24-point scale) was associated with higher risk of vertebral fracture and of major non-vertebral fracture (24). In a cohort of men aged 50 years and older followed up prospectively for 10 years, severe AAC (>6 on the 24-point scale) was associated with higher risk of fracture (25).…”

Section: Vascular Calcification and Fracture Riskmentioning

confidence: 99%

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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“…Although these conditions commonly co-occur in older adults, growing evidence suggests an association between vascular calcification and skeletal fragility that is independent of age and other shared risk factors. Older adults with the greatest bone loss have the greatest progression of vascular calcification 1,2 and the incidence of cardiovascular (CV) events is greater in women with lower bone mass 3 and in men with higher levels of bone resorption 4,5 . The association between both pathologies also depends on the mechanisms involved in the regulation of bone and CV metabolism 5 .…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Calcification and Bone: A Comparison of The Effects of Dietary and Serum Calcium, Phosphorous, Magnesium and Vitamin D

Nicoll¹

2015

ICFJ

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This comparison of the effects of calcium, phosphorus, magnesium and vitamin D on cardiovascular (CV) calcification and bone has shown that in general the micronutrients that promote bone health also protect the arteries. We have shown that adequate amounts of all three minerals should be ingested, paying particular attention to supplementing calcium to bind high phosphorus and to ensure the maximum benefit from supplementing vitamin D. It appears that the optimum intake for bone is >800 mg/d calcium, with postmenopausal women possibly requiring a total intake of >1100mg/d. Both CV and bone studies suggest achieving a serum 25(OH)D level of >75nmol/l. These relationships are valid for a Caucasian population, however, and may not hold in African Americans and Asians. The recent concerns that calcium supplementation may increase CV disease risk has largely proved groundless, with higher calcium intake improving dyslipidaemia, hypertension and mortality. With respect to higher serum phosphate, there is an association with CV calcification and CVD risk even within the normal range, suggesting that the reference ranges may need to be redefined for ‘at risk’ patients. CV calcification was reduced in CKD patients with magnesium intake in the range 384-669mg/d. When considering the complex interplay of the action of the minerals together with their regulators vitamin D, PTH and FGF23, it is clear that this is a very sophisticated system which attempts to maintain calcium homeostasis to the possible detriment of bone and arteries. This reinforces the need to ensure adequate calcium intake before supplementing vitamin D.

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The Association between Aortic Calcification and Fracture Risk in Postmenopausal Women in China: The Prospective Chongqing Osteoporosis Study

Cited by 23 publications

References 29 publications

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

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

Vascular calcification and fracture risk

Cardiovascular Calcification and Bone: A Comparison of The Effects of Dietary and Serum Calcium, Phosphorous, Magnesium and Vitamin D

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