Prevalent vertebral fracture (PVFx) and abdominal aortic calcification (AAC) independently predict incident atherosclerotic cardiovascular disease (ASCVD) events in older men

Author Identifier (ORCID)

Joshua R. Lewis: https://orcid.org/0000-0003-1003-8443

Afsah Saleem: https://orcid.org/0000-0001-7240-0837

S. Zulqarnain Gilani: https://orcid.org/0000-0002-7448-2327

Abstract

Purpose: To estimate the associations of prevalent vertebral fracture (PVFx) and abdominal aortic calcification (AAC) with incident ASCVD (myocardial infarction, fatal or non-fatal cerebrovascular accident, or coronary heart disease death). Methods: 2799 older men (mean [SD] age 76.3 [5.5] years) enrolled in the MrOS sleep ancillary study had PVFx (SQ grade 2 or 3) assessed by human reader and AAC by automated convolutional neural networks on baseline lateral spine radiographs. Auto-AAC was categorized as low, moderate, or high (24-point scale score < 2, 2 to <6, or ≥ 6). Men were contacted every 4 months for ascertainment of possible ASCVD events over a mean (SD) follow-up of 8.4 (3.1) years. Associations of PVFx and auto-AAC category with incident ASCVD were estimated with modified proportional hazards models accounting for non-CVD mortality. Results: PVFx was present in 7.3% of the cohort; 34.5% had moderate auto-AAC, 28.8% had high auto-AAC, and 396 (14.1%) had an incident ASCVD event. Compared to men with low auto-AAC, those with moderate (HR 1.34, 95% CI 1.01, 1.77) and high (HR 1.55, 95% CI 1.16, 2.06) auto-AAC had increased risk of ASCVD events adjusted for PVFx and other risk factors. Compared to men with no PVFx, those with PVFx had a higher risk of ASCVD events (HR 1.51, 95% CI 1.07, 2.14) adjusted for auto-AAC level and other risk factors. Conclusion: AAC assessed by automated methods and PVFx are independently associated with incident ASCVD events and may aid in ASCVD risk stratification in older men, but confirmatory studies are needed.

Keywords

AAC, abdominal aortic calcification, ASCVD, atherosclerotic cardiovascular disease, mace, major adverse cardiovascular events, vertebral fracture

Document Type

Journal Article

Date of Publication

8-1-2026

Volume

209

PubMed ID

41985702

Publication Title

Bone

Publisher

Elsevier

School

Nutrition and Health Innovation Research Institute / Centre for Artificial Intelligence and Machine Learning (CAIML) / School of Science

Funders

The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. The National Heart, Lung, and Blood Institute (NHLBI) provides funding for the MrOS Sleep ancillary study “Outcomes of Sleep Disorders in Older Men” under the following grant numbers: R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839.

Comments

Schousboe, J. T., Lewis, J. R., Langsetmo, L., Saleem, A., Gilani, S. Z., Ilyas, Z., Szulc, P., Leslie, W. D., & Ensrud, K. E. (2026). Prevalent vertebral fracture (PVFx) and abdominal aortic calcification (AAC) independently predict incident atherosclerotic cardiovascular disease (ASCVD) events in older men. Bone, 209, 117894. https://doi.org/10.1016/j.bone.2026.117894

Copyright

subscription content

Link to Full Text

Share

 
COinS
 

Link to publisher version (DOI)

10.1016/j.bone.2026.117894