Association between bone health and cardiovascular events in a population-based cohort

Abstract

Brief rationale: Low bone mineral density may be linked to cardiovascular risk, but causality is unclear.

Main result: In 1233 individuals followed for 14 years, osteoporotic fractures and trabecular vBMD independently predicted cardiovascular events, while areal BMD did not. Significance of the paper: Bone health could be associated with the development of cardiovascular events.

Purpose: In this observational cohort of a general population sample, we aimed to assess the association between bone mineral density (BMD) and osteoporotic fractures on the risk of subsequent cardiovascular events in both sexes.

Methods: This prospective study included 1233 individuals (mean age 62.5 ± 8.4 years; 76% women) from the Camargo cohort in Northern Spain, followed for 14.3 ± 4.0 years. Baseline clinical data, DXA-based BMD (lumbar spine, femoral neck, total hip), trabecular bone score (TBS), and volumetric BMD by 3D-DXA were analyzed. Incident cardiovascular events (myocardial infarction, stroke, peripheral artery disease) were documented. Cox regression analyses were performed adjusting for cardiovascular risk factors.

Results: During follow-up, 240 participants (19.5%) experienced cardiovascular events. These individuals were older and had higher rates of hypertension, diabetes, dyslipidemia, smoking, atrial fibrillation, and previous cardiovascular event. A history of osteoporotic fracture was more frequent among those with cardiovascular events (9.6% vs. 3.1%, HR 2.59). Lower trabecular vBMD and TBS were observed in the event group, while areal BMD showed no significant differences. Adjusted analyses revealed that a history of osteoporotic fracture independently increased cardiovascular risk by 125% (HR 2.25; 95% CI 1.43-3.54). Moreover, for each 1 SD increase in trabecular vBMD, the risk was slightly reduced by 14% (HR 0.86; 95% CI 0.74-0.99).

Conclusions: Our findings indicate that prior osteoporotic fractures and trabecular vBMD are significant predictors of cardiovascular event risk, independent of traditional risk factors.

Keywords: Bone mineral density (BMD); Cardiovascular disease (CVD); Fractures; Osteoporosis; Volumetric bone mineral density (vBMD).