Aortic calcification and the risk of osteoporosis and fractures.

We investigated the relation between computed tomography measures of aortic calcification and values for bone density and the number of fragility fractures in 2348 healthy, postmenopausal women. To determine whether increases in vascular calcification and bone loss progress in parallel, baseline values were compared with measurements obtained 9 months to 8 yr later in a subgroup of 228 women. Of the 2348 subjects studied, 70% had osteoporosis, 30% had at least one vertebral fracture, and 9% had at least one hip fracture. Aortic calcifications were inversely related to bone density and directly related to fractures. After adjusting for age and potential confounders, measures for aortic calcification predicted 26.1% of the variance in bone density (P < 0.001). Compared with women without calcification, the odds ratios for vertebral and hip fractures in those with calcification were estimated to be 4.8 (95% confidence interval, 3.6-6.5) and 2.9 (95% confidence interval, 1.8-4.8), respectively. The subgroup analysis of 228 women longitudinally studied showed that the percentage of yearly increase in aortic calcification accounted for 47% of the variance in the percentage rate of bone loss (P < 0.001). Moreover, a strong graded association was observed between the progression of vascular calcification and bone loss for each quartile. Women in the highest quartile for gains in aortic calcification had four times greater yearly bone loss (5.3 vs.1.3% yearly; P < 0.001) than women of similar age in the lowest quartile. Smaller, but highly significant differences were also found between all other quartiles. We conclude that aortic calcifications are a strong predictor for low bone density and fragility fractures.

[1]  Y. Ouchi,et al.  Age‐related Loss of Bone Mass and Aortic/Aortic Valve Calcification–Reevaluation of Recommended Dietary Allowance of Calcium in the Elderly a , 1993, Annals of the New York Academy of Sciences.

[2]  C. Vermeer,et al.  Characterization of a Gla-containing protein from calcified human atherosclerotic plaques. , 1990, Arteriosclerosis.

[3]  J P Binette,et al.  Chemical and physicochemical studies on the mineral deposits of the human atherosclerotic aorta. , 1980, Atherosclerosis.

[4]  Claus Christiansen,et al.  Diagnosis of Osteoporosis , 1992, Southern medical journal.

[5]  S. Cummings,et al.  Rate of Bone Loss Is Associated with Mortality in Older Women: A Prospective Study , 2000, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[6]  David J. Hand,et al.  Analysis of Repeated Measures , 1990 .

[7]  K. Watson,et al.  Mechanism of calcification in atherosclerosis. , 1994, Trends in cardiovascular medicine.

[8]  R. Detrano,et al.  Quantification of coronary artery calcium using ultrafast computed tomography. , 1990, Journal of the American College of Cardiology.

[9]  L. Banks,et al.  Effect of degenerative spinal and aortic calcification on bone density measurements in post‐menopausal women: links between osteoporosis and cardiovascular disease? , 1994, European journal of clinical investigation.

[10]  W. Edwards,et al.  Relation of coronary calcium determined by electron beam computed tomography and lumen narrowing determined by autopsy. , 1994, The American journal of cardiology.

[11]  A Hofman,et al.  Aortic calcified plaques and cardiovascular disease (the Framingham Study). , 1990, The American journal of cardiology.

[12]  C. Cooper,et al.  Epidemiology of fractures and assessment of fracture risk. , 2000, Clinics in laboratory medicine.

[13]  A. Hofman,et al.  Progression of aortic calcification is associated with metacarpal bone loss during menopause: a population-based longitudinal study. , 2000, Arteriosclerosis, thrombosis, and vascular biology.

[14]  S. Harris,et al.  Stimulation of bone formation in vitro and in rodents by statins. , 1999, Science.

[15]  Y. Yoshimoto,et al.  Bone changes and carotid atherosclerosis in postmenopausal women. , 1997, Stroke.

[16]  S. Majumdar,et al.  Noninvasive assessment of bone mineral and structure: State of the art , 1996, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[17]  F. Parhami,et al.  Atherogenic High‐Fat Diet Reduces Bone Mineralization in Mice , 2001, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[18]  D. F. Morrison,et al.  Multivariate Statistical Methods , 1968 .

[19]  J. Anderson,et al.  THE RELATION BETWEEN OSTEOPOROSIS AND AORTIC CALCIFICATION. , 1964, The British journal of radiology.

[20]  C. Dent,et al.  Osteoporosis of Lumbar Vertebrae and Calcification of Abdominal Aorta in Women Living in Durban , 1968, British medical journal.

[21]  I. Sekine,et al.  Femoral head necrosis and osteopenia in stroke-prone spontaneously hypertensive rats (SHRSPs). , 1993, Bone.

[22]  K. Watson,et al.  Bone morphogenetic protein expression in human atherosclerotic lesions. , 1993, The Journal of clinical investigation.

[23]  F. Massey,et al.  Introduction to Statistical Analysis , 1970 .

[24]  E. Barengolts,et al.  Osteoporosis and Coronary Atherosclerosis in Asymptomatic Postmenopausal Women , 1998, Calcified Tissue International.

[25]  D. Kiel,et al.  Bone loss and the progression of abdominal aortic calcification over a 25 year period: The Framingham heart study , 2001, Calcified Tissue International.

[26]  R. Verbeeck,et al.  Relation between osteoporosis and aorta calcification and its physiological explanation , 1991 .

[27]  P. Weissberg,et al.  High expression of genes for calcification-regulating proteins in human atherosclerotic plaques. , 1994, The Journal of clinical investigation.

[28]  H. Orimo,et al.  Ca and atherosclerosis. , 1985, Journal of nutritional science and vitaminology.

[29]  A. DeSmet,et al.  The effect of overlying calcification on lumbar bone densitometry , 1992, Calcified Tissue International.

[30]  M. Bots,et al.  Vitamin K Status and Bone Mass in Women With and Without Aortic Atherosclerosis: A Population-Based Study , 1996, Calcified Tissue International.

[31]  T. Fujita,et al.  Bone Changes and Aortic Calcification in Aging Inhabitants of Mountain Versus Seacoast Communities in the Kii Peninsula , 1984, Journal of the American Geriatrics Society.

[32]  I. Reid,et al.  Determinants of the rate of bone loss in normal postmenopausal women. , 1994, The Journal of clinical endocrinology and metabolism.

[33]  HMG-CoA reductase inhibitors and the risk of fractures. , 2000 .

[34]  M. Frye,et al.  Osteoporosis and calcification of the aorta. , 1992, Bone and mineral.

[35]  C. Edwards,et al.  Oral statins and increased bone-mineral density in postmenopausal women , 2000, The Lancet.

[36]  M. G. Kovar,et al.  The Supplement on Aging to the 1984 National Health Interview Survey. , 1987, Vital and health statistics. Ser. 1, Programs and collection procedures.

[37]  C. Hassager,et al.  The association between low bone mass at the menopause and cardiovascular mortality. , 1999, The American journal of medicine.

[38]  K. Becker,et al.  Calcification of the aorta and osteoporosis. A roentgenographic study. , 1972, JAMA.

[39]  W. Willett,et al.  Reproducibility and validity of a semiquantitative food frequency questionnaire. , 1985, American journal of epidemiology.

[40]  F. Epstein,et al.  A study of the correlation between roentgenographic and post-mortem calcification of the aorta. , 1954, American heart journal.

[41]  J. Sayre,et al.  Vertebral size in elderly women with osteoporosis. Mechanical implications and relationship to fractures. , 1995, The Journal of clinical investigation.

[42]  J. Cauley,et al.  Bone Mineral Density and Aortic Calcification: The Study of Osteoporotic Fractures , 1997, Journal of the American Geriatrics Society.

[43]  B. Mazières,et al.  Comparison of the bone mineral content of the lower limbs in men with ischaemic atherosclerotic disease , 1994, Clinical Rheumatology.

[44]  S. Cummings,et al.  Non-trauma mortality in elderly women with low bone mineral density , 1991, The Lancet.