Association Between Abdominal Aortic Calcification, Bone Mineral Density, and Fracture in Older Women

Joshua R. Lewis, Celeste J. Eggermont, John T. Schousboe, Wai H. Lim, Germaine Wong, Ben Khoo, Marc Sim, Ming Xiang Yu, Thor Ueland, Jens Bollerslev, Jonathan M. Hodgson, Kun Zhu, Kevin E. Wilson, Douglas P. Kiel, Richard L. Prince

Research output: Contribution to journalArticle

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 1024 older predominantly white 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 to 5, n = 373), and severe AAC (score >6, n = 192). Prevalent vertebral fractures were calculated using the Genant semiquantitative method. AAC24 scores were inversely related to hip BMD (rs = –0.077, p = 0.013), heel broadband ultrasound attenuation (rs = –0.074, p = 0.020), and the 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 lumbar spine imaging-detected lumbar spine fractures, but not thoracic spine fractures (Mantel-Haenszel 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; 95% CI, 1.15 to 1.91; p = 0.002; HR 1.46; 95% CI, 1.07 to 1.99; p = 0.019, respectively) compared with women with low AAC. This relationship remained significant after adjusting for age and hip BMD for clinical fractures (HR 1.40; 95% CI, 1.08 to 1.81; p = 0.010), but was attenuated for fracture-related hospitalizations (HR 1.33; 95% CI, 0.98 to 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

Original languageEnglish
JournalJournal of Bone and Mineral Research
DOIs
Publication statusPublished - Oct 2019

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Bone Fractures
Bone Density
Spine
Hip
Heel
Vascular Diseases
Osteoporosis
Vascular Calcification
Bone and Bones
Densitometry
Causality
Longitudinal Studies
Hospitalization
Thorax
Cross-Sectional Studies
Pathology

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Lewis, Joshua R. ; Eggermont, Celeste J. ; Schousboe, John T. ; Lim, Wai H. ; Wong, Germaine ; Khoo, Ben ; Sim, Marc ; Yu, Ming Xiang ; Ueland, Thor ; Bollerslev, Jens ; Hodgson, Jonathan M. ; Zhu, Kun ; Wilson, Kevin E. ; Kiel, Douglas P. ; Prince, Richard L. / Association Between Abdominal Aortic Calcification, Bone Mineral Density, and Fracture in Older Women. In: Journal of Bone and Mineral Research. 2019.
@article{0d49f7b97ef24bafbd9837786ee7264d,
title = "Association Between Abdominal Aortic Calcification, Bone Mineral Density, and Fracture in Older Women",
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 1024 older predominantly white 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 to 5, n = 373), and severe AAC (score >6, n = 192). Prevalent vertebral fractures were calculated using the Genant semiquantitative method. AAC24 scores were inversely related to hip BMD (rs = –0.077, p = 0.013), heel broadband ultrasound attenuation (rs = –0.074, p = 0.020), and the 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 lumbar spine imaging-detected lumbar spine fractures, but not thoracic spine fractures (Mantel-Haenszel 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; 95{\%} CI, 1.15 to 1.91; p = 0.002; HR 1.46; 95{\%} CI, 1.07 to 1.99; p = 0.019, respectively) compared with women with low AAC. This relationship remained significant after adjusting for age and hip BMD for clinical fractures (HR 1.40; 95{\%} CI, 1.08 to 1.81; p = 0.010), but was attenuated for fracture-related hospitalizations (HR 1.33; 95{\%} CI, 0.98 to 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",
keywords = "ABDOMINAL AORTIC CALCIFICATION, BONE MINERAL DENSITY, ELDERLY WOMEN, FRACTURE, HEEL QUANTITATIVE ULTRASOUND, LATERAL SPINE IMAGING, OSTEOPOROSIS, VASCULAR CALCIFICATION",
author = "Lewis, {Joshua R.} and Eggermont, {Celeste J.} and Schousboe, {John T.} and Lim, {Wai H.} and Germaine Wong and Ben Khoo and Marc Sim and Yu, {Ming Xiang} and Thor Ueland and Jens Bollerslev and Hodgson, {Jonathan M.} and Kun Zhu and Wilson, {Kevin E.} and Kiel, {Douglas P.} and Prince, {Richard L.}",
year = "2019",
month = "10",
doi = "10.1002/jbmr.3830",
language = "English",
journal = "Journal of Bone & Mineral Research",
issn = "0884-0431",
publisher = "John Wiley & Sons",

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Association Between Abdominal Aortic Calcification, Bone Mineral Density, and Fracture in Older Women. / Lewis, Joshua R.; Eggermont, Celeste J.; Schousboe, John T.; Lim, Wai H.; Wong, Germaine; Khoo, Ben; Sim, Marc; Yu, Ming Xiang; Ueland, Thor; Bollerslev, Jens; Hodgson, Jonathan M.; Zhu, Kun; Wilson, Kevin E.; Kiel, Douglas P.; Prince, Richard L.

In: Journal of Bone and Mineral Research, 10.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association Between Abdominal Aortic Calcification, Bone Mineral Density, and Fracture in Older Women

AU - Lewis, Joshua R.

AU - Eggermont, Celeste J.

AU - Schousboe, John T.

AU - Lim, Wai H.

AU - Wong, Germaine

AU - Khoo, Ben

AU - Sim, Marc

AU - Yu, Ming Xiang

AU - Ueland, Thor

AU - Bollerslev, Jens

AU - Hodgson, Jonathan M.

AU - Zhu, Kun

AU - Wilson, Kevin E.

AU - Kiel, Douglas P.

AU - Prince, Richard L.

PY - 2019/10

Y1 - 2019/10

N2 - 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 1024 older predominantly white 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 to 5, n = 373), and severe AAC (score >6, n = 192). Prevalent vertebral fractures were calculated using the Genant semiquantitative method. AAC24 scores were inversely related to hip BMD (rs = –0.077, p = 0.013), heel broadband ultrasound attenuation (rs = –0.074, p = 0.020), and the 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 lumbar spine imaging-detected lumbar spine fractures, but not thoracic spine fractures (Mantel-Haenszel 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; 95% CI, 1.15 to 1.91; p = 0.002; HR 1.46; 95% CI, 1.07 to 1.99; p = 0.019, respectively) compared with women with low AAC. This relationship remained significant after adjusting for age and hip BMD for clinical fractures (HR 1.40; 95% CI, 1.08 to 1.81; p = 0.010), but was attenuated for fracture-related hospitalizations (HR 1.33; 95% CI, 0.98 to 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

AB - 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 1024 older predominantly white 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 to 5, n = 373), and severe AAC (score >6, n = 192). Prevalent vertebral fractures were calculated using the Genant semiquantitative method. AAC24 scores were inversely related to hip BMD (rs = –0.077, p = 0.013), heel broadband ultrasound attenuation (rs = –0.074, p = 0.020), and the 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 lumbar spine imaging-detected lumbar spine fractures, but not thoracic spine fractures (Mantel-Haenszel 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; 95% CI, 1.15 to 1.91; p = 0.002; HR 1.46; 95% CI, 1.07 to 1.99; p = 0.019, respectively) compared with women with low AAC. This relationship remained significant after adjusting for age and hip BMD for clinical fractures (HR 1.40; 95% CI, 1.08 to 1.81; p = 0.010), but was attenuated for fracture-related hospitalizations (HR 1.33; 95% CI, 0.98 to 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

KW - ABDOMINAL AORTIC CALCIFICATION

KW - BONE MINERAL DENSITY

KW - ELDERLY WOMEN

KW - FRACTURE

KW - HEEL QUANTITATIVE ULTRASOUND

KW - LATERAL SPINE IMAGING

KW - OSTEOPOROSIS

KW - VASCULAR CALCIFICATION

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U2 - 10.1002/jbmr.3830

DO - 10.1002/jbmr.3830

M3 - Article

JO - Journal of Bone & Mineral Research

JF - Journal of Bone & Mineral Research

SN - 0884-0431

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