The associations between bone mineral density and long-term risks of cardiovascular disease, cancer, and all-cause mortality

Abstract

ObjectiveWe aimed to investigate the associations between bone mineral density and long-term risks of cardiovascular disease (CVD), cancer, and all-cause mortality in nationwide survey participants aged 18 and over.MethodsUsing data from the United States National Health and Nutrition Examination Survey III (NHANES III), the associations of bone mineral density (normal bone mass, osteopenia, and osteoporosis) with CVD, cancer, and all-cause mortality were analyzed using the Cox proportional hazards model.ResultsA total of 11,909 adults aged 18 and over were enrolled in this study. Compared with the participants with normal bone mass, those with osteoporosis and osteopenia were more likely to be female, of non-Hispanic white ethnicity, and older. They were also more likely to have lower calcium and vitamin D intakes, a lower body mass index (BMI), lower educational attainment, and lower family incomes. Participants with osteoporosis and osteopenia also engaged in less physical activity and were more likely to have diabetes, high blood pressure, and a history of CVD. After adjusting for confounders, osteopenia and osteoporosis were significantly associated with all-cause mortality, with the hazard ratios (95% confidence intervals) being 1.37 (1.11, 1.68) and 1.06 (0.91, 1.25), respectively, compared with normal bone mass. Age (P for interaction = 0.001) and BMI (P for interaction = 0.002) were found to modify the association between bone mineral density and all-cause mortality.ConclusionsIn a nationally representative cohort, osteoporosis was associated with an increased risk of all-cause mortality, and this association was stronger in participants who were older and had a lower BMI.

Bone Mineral Density is positively associated with risk of All-Cause and Cardiovascular Mortality among Adults with Type 2 Diabetes Mellitus:a cross-sectional study of the NHANES 2005-2010,2013-2014

“…Some previous studies had reported a correlation between BMD or osteoporosis and the risk of all-cause mortality and CVD mortality.Research by Cai S showed that total femur (HR = 1.36, 95% CI = 1.07-1.73), femur neck (HR = 1.41, 95% CI = 1.11-1.78), intertrochanter (HR = 1.34, 95% CI = 1.05-1.72), and entire body (HR = 1.36, 95% CI = 1.09-1.69) osteoporotic participants had a higher risk of all-cause mortality compared with normal participants.However,the statistically signi cant L-shaped relationships were only identi ed for heart disease mortality with BMD increment within certain limits in the femur, whereas the remarkable relationships disappeared after BMD continued to increase [14].Other ndings from nationally representative cohorts also suggested that osteoporosis was associated with an increased risk of all-cause mortality(HR = 1.37, 95% CI = 1.11, 1.68), and this association was stronger in participants who were older and had a lower BMI.Similarly, non-signi cant results were observed for osteoporosis with CVD mortality in their study, the non-signi cant results might be due to the lower number of incident CVD, and cancer deaths, and short-time follow-up [15].Other studies had drawn some positive conclusions on the relationship between osteoporosis and cardiovascular disease risk.Irene's study included a total of 305,072 UK Biobank participants diagnosed with osteoporosis at baseline, the study concluded that men with osteoporosis had a higher mortality risk from CVD(HR = 1.68,95%CI = 1.19-2.37).However, women with osteoporosis only had a higher risk of incident CVD(HR = 1.24,95%CI = 1.97-1.44),and the risk of CVD mortality was not affected [16].Calcaneal quantitative ultrasound (QUS) was utilized to assess bone material properties, particularly in elderly women, and could also be used to diagnose osteoporosis.In a prospective study of aged women, A. K. Gebre found that quantitative ultrasound measurements of the calcaneus were independently associated with increased cardiovascular and all-cause mortality, independent of established cardiovascular risk factors.Reduction in broadband ultrasound attenuation (BUA) in the minimally and multi-variable adjusted model including cardiovascular risk factors increased relative hazard for all-cause mortality (HR = 1.15,95%CI = 1.06-1.261) and CVD mortality (HR = 1.20,95%CI = 1.04-1.38).Nonetheless, this observational study was limited to geriatric females only, and the results were not founded on the analysis of BMD values [17].In a similar study called the AA-DHS, vertebral BMD(vBMD) was analyzed in 675 African American men with T2DM and the results suggested that lower vBMD was associated with increased all-cause mortality, but regrettably, this study also showed that lower vBMD was not linked to other mortality risk factors, including subclinical atherosclerosis [18].…”

Total Muscle Area and Visceral Adipose Tissue Measurements for Frailty Assessment in TAVR Patients

“…Additionally, comprehensive frailty assessments often incorporate further parameters, such as low bone mineral density. However, although low bone mineral density is significantly associated with an increased cardiovascular risk regarding the interaction of low bone mineral density and TAVR outcome, only spare data are available [ 27 , 28 ].…”

Low Bone Mineral Density on Computed Tomography: Association with Poor Survival after Transcatheter Aortic Valve Replacement

“…In noncardiac diseases, low BMD has been independently associated with poor prognosis, particularly in cancer patients [36,37]. Lower BMD was also significantly associated with increased cardiovascular risk [21,22]. The main complications as a consequence of low BMD are OP and osteoporotic fracture, which leads to frailty in older patients [22].…”

“…Research has consistently demonstrated a robust association between low BMD and an elevated risk of cardiovascular events, highlighting the intricate relationship between musculoskeletal health and overall cardiovascular health [21,22]. For instance, individuals with lower BMD have been shown to be at an increased risk of mortality, particularly among male populations [23].…”

“…OP and osteoporotic fractures are associated with disability, impaired quality of life, and mortality [26,27]. Studies consistently highlight the association between low BMD and heightened mortality risk, underscoring the importance of considering bone health in clinical decision making [22,28]. Also, multimorbidity is common in individuals with osteoporosis, and early identification not only allows for the implementation of treatment strategies but also presents an opportunity to improve decision making in frail patients [27].…”