Document Type

Journal Article

Publication Title

Journal of Bone and Mineral Research

ISSN

1523-4681

PubMed ID

31310354

Publisher

American Society for Bone and Mineral Research

School

School of Medical and Health Sciences

RAS ID

28945

Funders

National Health and Medical Research Council

Grant Number

NHMRC Number : 1107474

Comments

This is an Author's Accepted Manuscript of Lewis, J. R., Eggermont, C. J., Schousboe, J. T., Lim, W. H., Wong, G., Khoo, B., ... Prince, R. L. (2019). Association between abdominal aortic calcification, bone mineral density and fracture in older women. Journal of Bone and Mineral Research. 34(11) 2052-2060.

https://doi.org/10.1002/jbmr.3830

Abstract

Although a relationship between vascular disease and osteoporosis has been recognized, its clinical importance for fracture risk evaluation remains uncertain. Abdominal aortic calcification (AAC), a recognized measure of vascular disease detected on single‐energy images performed for vertebral fracture assessment, may also identify increased osteoporosis risk. In a prospective 10‐year study of 1,024 older predominantly Caucasian women (mean age 75.0±2.6 years) from the Perth Longitudinal Study of Aging cohort we evaluated the association between AAC, skeletal structure and fractures. AAC and spine fracture were assessed at the time of hip densitometry and heel quantitative ultrasound. AAC was scored 0 to 24 (AAC24) and categorized into; low AAC (score 0 and 1, n=459), moderate AAC (score 2‐5, n=373) and severe AAC (score > 6, n=192). Prevalent vertebral fractures were calculated using the Genant semi‐quantitative method. AAC24 scores were inversely related to hip bone mineral density (BMD) (rs=‐0.077, p=0.013) and heel broadband ultrasound attenuation (rs=‐0.074, p=0.020) and stiffness index (rs=‐0.073, p=0.022). In cross‐sectional analyses women with moderate to severe AAC were more likely to have prevalent fracture and LSI detected lumbar spine but not thoracic spine fractures (Mantel‐Haentzel test of trend p < 0.05). For 10‐year incident clinical fractures and fracture‐related hospitalizations women with moderate to severe AAC (AAC24 score >1) had increased fracture risk (HR 1.48 [1.15‐1.91], p=0.002; HR 1.46 [1.07‐1.99], p=0.019, respectively) compared to women with low AAC. This relationship remained significant after adjusting for age and hip BMD for clinical fractures (HR 1.40 [1.08‐1.81], p=0.010) but was attenuated for fracture‐related hospitalizations (HR 1.33 [0.98‐1.83], p=0.073). In conclusion, older women with more marked AAC are at higher risk of fracture, not completely captured by bone structural predictors. These findings further support the concept that vascular calcification and bone pathology may share similar mechanisms of causation that remain to be fully elucidated.

DOI

10.1002/jbmr.3830

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