Osteoporosis International

, Volume 28, Issue 7, pp 2239–2245 | Cite as

Associations between hip bone mineral density, aortic calcification and cardiac workload in community-dwelling older Australians

  • A. J. Rodríguez
  • D. Scott
  • A. Hodge
  • D. R. English
  • G. G. Giles
  • P. R. Ebeling
Short Communication
First Online:
Received:
Accepted:

Abstract

Summary

In older adults, lower bone density in the proximal femur was associated with increased heart burden, and this association was linked to calcification in the aorta. These results were seen in women but not in men.

Purpose

To determine whether there is an association between lower bone mineral density (BMD) and increased cardiac workload in older adults, and if this association was independent of abdominal aortic calcification (AAC).

Methods

Three hundred thirty-seven participants [mean ± SD age = 70 ± 5 years and BMI = 28 ± 5 kg/m2, 61% females] had BMD determined by dual-energy X-ray absorptiometry and AAC determined by radiography. Aortic calcification score (ACS) was determined visually in the L1-L4 vertebrae (range 0–24). Systolic blood pressure (BP) and heart rate (HR) were measured. The rate pressure product (RPP), a measure of cardiac workload, was determined by multiplying BP and HR.

Results

AAC was present in 205 (61%) participants. Mean ± SD RPP was 9120 ± 1823; range was 5424–18,537. In all participants, ACS was positively associated with log-transformed RPP [LnRPP] (β = 0.011, p < 0.001), and severe calcification was positively associated with LnRPP (β = 0.083, p = 0.004 relative to no calcification). In sex-stratified analyses, these associations were significant only in females. Lower odds of any AAC were observed per 1 g/cm2 increment in femoral neck BMD (OR = 0.08, 95% CI 0.01–0.95). A similar trend was evident in women separately (OR = 0.05, 95% CI 0–1.17) but not men. In all participants, femoral neck (β = −0.20, p = 0.04) and total hip BMD (β = −0.17, p = 0.04) were inversely associated with LnRPP after multivariate adjustment. Adjusting additionally for AAC reduced the strength of the association in femoral neck (β = −0.19, p = 0.05) but not total hip BMD (β = −0.17, p = 0.04).

Conclusion

Lower BMD was marginally, but significantly with increased LnRPP, and this relationship was partially mediated by AAC suggesting that older adults, particularly females, with osteoporosis may have an increased cardiovascular risk.

Keywords

Ageing Aortic calcification Blood pressure Bone Cardiovascular disease 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

MCCS cohort recruitment was funded by VicHealth and Cancer Council Victoria. The MCCS was further supported by Australian NHMRC grants 209057, 251553 and 504711 and by infrastructure provided by Cancer Council Victoria. Cases and their vital status were ascertained through the Victorian Cancer Registry (VCR) and the Australian Institute of Health and Welfare (AIHW), including the National Death Index and the Australian Cancer Database. AJR was supported by an Australian Government Research Training Programme Scholarship. DS is support by an Australian Government National Health and Medical Research Council RD Wright Biomedical Career Development Fellow. The authors would like to acknowledge Dr. Belal Khan and Dr. Nayab Khan for their efforts in recruitment for this study, calcification scoring and in database preparation.

Compliance with ethical standards

Conflict of interest

None.

Supplementary material

198_2017_4024_MOESM1_ESM.pptx (34 kb)
Supplementary Figure 1 (PPTX 34 kb)
198_2017_4024_MOESM2_ESM.docx (62 kb)
Supplementary Figure 2 (DOCX 61 kb)

References

  1. 1.
    Hak AE, Pols HA, van Hemert AM, Hofman A, Witteman JC (2000) Progression of aortic calcification is associated with metacarpal bone loss during menopause: a population-based longitudinal study. Arterioscler Thromb Vasc Biol 20(8):1926–1931CrossRefPubMedGoogle Scholar
  2. 2.
    Elmariah S, Delaney JA, Bluemke DA et al (2012) Associations of LV hypertrophy with prevalent and incident valve calcification: multi-ethnic study of atherosclerosis. JACC Cardiovascular imaging 5(8):781–788CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Azevedo J, Arroja I, Jacques A et al (1993) A double ambulatory product (blood pressure and heart rate), mild arterial hypertension and left ventricular hypertrophy. Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology 12(7–8):663–673 602 Google Scholar
  4. 4.
    Giles GG, English DR (2002) The Melbourne collaborative cohort study. IARC Sci Publ 156:69–70PubMedGoogle Scholar
  5. 5.
    Khan B, Nowson CA, Daly RM et al (2015) Higher dietary calcium intakes are associated with reduced risks of fractures, cardiovascular events, and mortality: a prospective cohort study of older men and women. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 30(10):1758–1766CrossRefGoogle Scholar
  6. 6.
    Gobel FL, Norstrom LA, Nelson RR, Jorgensen CR, Wang Y (1978) The rate-pressure product as an index of myocardial oxygen consumption during exercise in patients with angina pectoris. Circulation 57(3):549–556CrossRefPubMedGoogle Scholar
  7. 7.
    Kauppila LI, Polak JF, Cupples LA, Hannan MT, Kiel DP, Wilson PW (1997) New indices to classify location, severity and progression of calcific lesions in the abdominal aorta: a 25-year follow-up study. Atherosclerosis 132(2):245–250CrossRefPubMedGoogle Scholar
  8. 8.
    Baron RM, Kenny DA (1986) The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51(6):1173–1182CrossRefPubMedGoogle Scholar
  9. 9.
    Tankó LB, Christiansen C, Cox DA, Geiger MJ, McNabb MA, Cummings SR (2005) Relationship between osteoporosis and cardiovascular disease in postmenopausal women. J Bone Miner Res 20(11):1912–1920CrossRefPubMedGoogle Scholar
  10. 10.
    Tanko LB, Bagger YZ, Christiansen C (2003) Low bone mineral density in the hip as a marker of advanced atherosclerosis in elderly women. Calcif Tissue Int 73(1):15–20CrossRefPubMedGoogle Scholar
  11. 11.
    Fodor D, Bondor C, Albu A et al (2011) Relation between intima-media thickness and bone mineral density in postmenopausal women: a cross-sectional study. Sao Paulo medical journal. Rev Paul Med 129(3):139–145Google Scholar
  12. 12.
    Lim YH, Shin J, Lee JU et al (2010) Bone mineral density is an independent determinant of left ventricular mass index in the general Female population. Korean circulation journal 40(11):573–580CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Liu T, Lin J, Ju T, Chu L, Zhang L (2015) Vascular smooth muscle cell differentiation to an osteogenic phenotype involves matrix metalloproteinase-2 modulation by homocysteine. Mol Cell Biochem 406(1–2):139–149CrossRefPubMedGoogle Scholar
  14. 14.
    Zhang J, Zheng B, Zhou PP et al (2014) Vascular calcification is coupled with phenotypic conversion of vascular smooth muscle cells through Klf5-mediated transactivation of the Runx2 promoter. Biosci Rep 34(6):e00148CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kiel DP, Kauppila LI, Cupples LA, Hannan MT, O'Donnell CJ, Wilson PW (2001) Bone loss and the progression of abdominal aortic calcification over a 25 year period: the Framingham Heart Study. Calcif Tissue Int 68(5):271–276CrossRefPubMedGoogle Scholar
  16. 16.
    Innasimuthu AL, Katz WE (2011) Effect of bisphosphonates on the progression of degenerative aortic stenosis. Echocardiography (Mount Kisco, NY) 28(1):1–7CrossRefGoogle Scholar
  17. 17.
    Bos D, Leening MJ, Kavousi M, et al. (2015) Comparison of Atherosclerotic Calcification in Major Vessel Beds on the Risk of All-Cause and Cause-Specific Mortality: The Rotterdam Study. Circ Cardiovasc Imaging 8(12)Google Scholar
  18. 18.
    Cheng SL, Shao JS, Halstead LR, Distelhorst K, Sierra O, Towler DA (2010) Activation of vascular smooth muscle parathyroid hormone receptor inhibits Wnt/beta-catenin signaling and aortic fibrosis in diabetic arteriosclerosis. Circ Res 107(2):271–282CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Aggarwal SR, Clavel MA, Messika-Zeitoun D et al (2013) Sex differences in aortic valve calcification measured by multidetector computed tomography in aortic stenosis. Circulation Cardiovascular imaging 6(1):40–47CrossRefPubMedGoogle Scholar
  20. 20.
    Hodis HN, Mack WJ, Henderson VW et al (2016) Vascular effects of early versus late postmenopausal treatment with estradiol. N Engl J Med 374(13):1221–1231CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2017

Authors and Affiliations

  • A. J. Rodríguez
    • 1
  • D. Scott
    • 1
    • 2
    • 3
  • A. Hodge
    • 4
    • 5
  • D. R. English
    • 4
    • 5
  • G. G. Giles
    • 4
    • 5
  • P. R. Ebeling
    • 1
    • 2
    • 3
  1. 1.Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health SciencesMonash University, Monash Medical CentreClaytonAustralia
  2. 2.Melbourne Medical School (Western Campus)University of MelbourneSt AlbansAustralia
  3. 3.Australian Institute for Musculoskeletal ScienceSt AlbansAustralia
  4. 4.Cancer Epidemiology & Intelligence Division, Cancer Council VictoriaMelbourneAustralia
  5. 5.Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthUniversity of MelbourneParkvilleAustralia

Personalised recommendations