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

J. I. Barzilay, P. Buzkova, J. A. Cauley, John A Robbins, H. A. Fink, K. J. Mukamal

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)2219-2230
Number of pages12
JournalOsteoporosis International
Volume29
Issue number10
DOIs
StatePublished - Oct 1 2018

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Pelvic Bones
Hip Fractures
Tunica Intima
Bone Density
Cardiovascular Diseases
Carotid Arteries
Health
Bone and Bones
Ankle Brachial Index
Common Carotid Artery
Internal Carotid Artery
Ankle
Osteoporosis
Blood Vessels
Atherosclerosis
Arm
Blood Pressure

Keywords

  • Bone mineral density
  • Hip fracture
  • Risk
  • Subclinical atherosclerosis

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

The associations of subclinical atherosclerotic cardiovascular disease with hip fracture risk and bone mineral density in elderly adults. / Barzilay, J. I.; Buzkova, P.; Cauley, J. A.; Robbins, John A; Fink, H. A.; Mukamal, K. J.

In: Osteoporosis International, Vol. 29, No. 10, 01.10.2018, p. 2219-2230.

Research output: Contribution to journalArticle

Barzilay, J. I. ; Buzkova, P. ; Cauley, J. A. ; Robbins, John A ; Fink, H. A. ; Mukamal, K. J. / The associations of subclinical atherosclerotic cardiovascular disease with hip fracture risk and bone mineral density in elderly adults. In: Osteoporosis International. 2018 ; Vol. 29, No. 10. pp. 2219-2230.
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N2 - 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.

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