The Relationship of Pulse Pressure and Bone Mineral Density in Adult USA Population: Analysis of the National Health and Nutritional Examination Survey

Abstract

Background/Purpose:Accumulating evidence indicates a relationship between Cardiovascular Disease (CVD) and osteoporosis. Hypertension, a known risk factor for CVD is also associated with low Bone Mineral Density (BMD). We hypothesize that Pulse Pressure (PP); a CVD risk factor is associated with BMD.Methods:Data from two consecutive cycles of National Health and Nutritional Examination Survey (NHANES) from 2009–2010 and 2011–2012. Point estimates of demographic variables were calculated using descriptive methods. Study participants were divided into 4 groups based on quartile distribution of PP. Multivariate linear regression analysis was performed to assess the relationship between BMD and PP.Results:A total of 8,179 NHANES participants were included in the study (Tables 1–3). The cohort’s mean age (± SE) was 53.3 years 0.19, mean BMI (± SE) 29.6 kg/m2 ± 0.07. PP was significantly higher with increased age, among Blacks (57.4 ± 0.52) and Hispanics (57.5 ± 0.19) compared to whites (53.9 ± 0.29), and for men (57.2 ± 0.16) when compared to women (54.1 ± 0.17), p<0.05. After adjusting for age, sex, race, menopause, body mass index, family history of osteoporosis, PP was associated with femoral neck BMD, β=−0.0005, p<0.05 but was not significantly associated with lumbar spine BMD, β=−0.0002, p=0.07.Conclusion:Our results support the hypothesis that wide PP is associated with low BMD. This negative association was demonstrated at the femoral neck where bone loss and osteoporotic fractures occur at a more advanced stage, further supporting the relationship between atherosclerosis and osteoporosis risk. These findings have the potential for identifying high osteoporotic risk patients among those with wide pulse pressure, providing further indications for bone mineral density testing among these elderly frail patients. Further research is needed to investigate the mechanisms behind the relationship between PP and BMD.

Causal Effect of Blood Pressure on Bone Mineral Density and Fracture: A Mendelian Randomization Study

“…PP is defined as SBP minus DBP. High PP largely results from large-artery stiffness, while decreased PP is caused by low stroke volume, such as congestive heart failure and aortic valve stenosis ( 33 ). Vascular smooth muscle cells (VSMC) have important roles in regulating arterial stiffness by overproducing various extracellular matrix components (e.g., collagen and elastin), which provide biomechanical, structural integrity, and signaling regulation of the extracellular matrix components to maintain vascular homeostasis ( 34 , 35 ).…”

Association of life's essential 8 and risk of fragility fractures: A large cohort study

“…18 McFarlane and colleagues found that increased pulse pressure was associated with decreased femoral neck bone mineral density (BMD), revealing a relationship between atherosclerosis and osteoporosis risk. 19 Another study found that atrial fibrillation was an independent risk factor for nonaccidental falls. For people younger than 81 years of age, the risk of nonaccidental falls was 2.5 times higher for those with a history of atrial fibrillation than those without it, and this may be related to reduced cardiac output, bradycardia, and orthostatic hypotension caused by atrial fibrillation.…”

“…Increased pulse pressure is associated with atherosclerosis and is a predictor of the risk of cardiovascular disease 18 . McFarlane and colleagues found that increased pulse pressure was associated with decreased femoral neck bone mineral density (BMD), revealing a relationship between atherosclerosis and osteoporosis risk 19 . Another study found that atrial fibrillation was an independent risk factor for nonaccidental falls.…”