The associations of subclinical atherosclerotic cardiovascular disease with hip fracture risk and bone mineral density in elderly adults

• Type of Material: Article
• Authors: Joshua I. Barzilay, Emory University; Petra Buzkova, University of Washington; Jane A. Cauley, University of Pittsburgh; John A. Robbins, University of California, Davis; Howard A. Fink, VA Health Care System; Kenneth J. Mukamal, Beth Israel Deaconess Medical Center
• Language: English
• Date: 2018-10-01
• Publisher: Springer (part of Springer Nature): Springer Open Choice Hybrid Journals - CC-BY-NC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018, International Osteoporosis Foundation and National Osteoporosis Foundation.
• Final Published Version (URL): http://dx.doi.org/10.1007/s00198-018-4611-9
• Title of Journal or Parent Work: Osteoporosis International
• ISSN: 0937-941X
• Volume: 29
• Issue: 10
• Start Page: 2219
• End Page: 2230
• Grant/Funding Information: This research was supported by contracts HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086; and grant U01HL080295 from the National Heart, Lung, and Blood Institute (NHLBI);with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS).; Additional support was provided by R01AG023629 from the National Institute on Aging (NIA).
• Keywords: Endocrinology & Metabolism; SYSTEMIC-LUPUS-ERYTHEMATOSUS; OLDER-ADULTS; POPULATION; Science & Technology; POSTMENOPAUSAL WOMEN; PERIPHERAL ARTERIAL-DISEASE; Life Sciences & Biomedicine; VERTEBRAL FRACTURES; Subclinical atherosclerosis; Bone mineral density; HEALTH; ABDOMINAL AORTIC-ANEURYSMS; Risk; INTIMA-MEDIA THICKNESS; CAROTID ATHEROSCLEROSIS; Hip fracture
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Summary: In the absence of clinically recognized cardiovascular disease, increased carotid artery intimal medial thickness was associated with higher hip fracture risk in older adults, despite its association with higher bone mineral density (BMD). Low ankle brachial index and aortic wall thickness were not associated with fracture risk or BMD. Introduction: Clinically recognized cardiovascular disease (CVD) is associated with osteoporosis and hip fracture risk, but the relationship of subclinical atherosclerosis to bone health is not certain. Methods: We followed 3385 participants from the Cardiovascular Health Study (mean age 74.7 ± 5.3 years) with a median time to fracture of 12.1 years who underwent baseline carotid artery and aortic wall ultrasound scanning and ankle brachial blood pressure index (ABI) determinations. A subset underwent bone mineral density (BMD) testing. Results: There were 494 hip fractures during follow-up. Among persons without clinical CVD, an average standard-deviation increase in a composite score of maximal common and internal carotid artery intimal medial thickness (cIMT) was associated with increased risk of hip fracture [(HR 1.18 [1.04, 1.35]), even though cIMT was positively associated with BMD. Neither aortic wall thickness nor ABI were associated with hip fracture risk or BMD. Among participants with clinical CVD, cIMT and aortic wall thickness, but not ABI, were associated with increased hip fracture risk. Conclusion: Subclinical cIMT is associated with an increased risk of hip fractures despite being associated with increased BMD. This finding suggests that vascular health, even in its early stages, is linked to bone health, by pathways other than BMD.