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

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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.

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Authors and Affiliations

  1. Kaiser Permanente of Georgia, Division of Endocrinology and the Division of Endocrinology, Emory University School of Medicine, 3650 Steve Reynolds Blvd, Duluth, GA, 30096, USA

    J. I. Barzilay

  2. Department of Biostatistics, University of Washington, Seattle, WA, USA

    P. Buzkova

  3. Department of Epidemiology, Graduate School, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    J. A. Cauley

  4. Department of Medicine, University of California at Davis, Modesto, CA, USA

    J. A. Robbins

  5. Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, MN, USA

    H. A. Fink

  6. Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, USA

    K. J. Mukamal

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  1. J. I. Barzilay
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  2. P. Buzkova
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  3. J. A. Cauley
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  4. J. A. Robbins
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  5. H. A. Fink
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  6. K. J. Mukamal
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Correspondence to J. I. Barzilay.

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Appendix

Appendix

Table 5 Studies from 2013 to 2017 of subclinical cardiovascular disease and bone mineral density and/or fracture risk (taken from Pubmed 2013 through March 2018 using term “atherosclerosis” and “fracture”; “atherosclerosis” and “hip fracture”; “atherosclerosis” and “bone mineral density”; “fracture” and “subclinical disease”). Results categorized by the presence or absence of a significant association
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Table 6 Hazard ratios for hip fracture associated with subclinical vascular disease in the absence of clinical cardiovascular disease categorized by 5 years follow-up and 10 years follow-up. Results are for fully adjusted models: age, sex, black race, current smoking, alcohol (0 ref., 1–7, > 7 drinks), weight (kg), diabetes, hypertension, eGFR based on cystatin, and estrogen use in women
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Barzilay, J.I., Buzkova, P., Cauley, J.A. et al. The associations of subclinical atherosclerotic cardiovascular disease with hip fracture risk and bone mineral density in elderly adults. Osteoporos Int 29, 2219–2230 (2018). https://doi.org/10.1007/s00198-018-4611-9

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  • DOI: https://doi.org/10.1007/s00198-018-4611-9

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