Calcified Tissue International

, Volume 78, Issue 1, pp 1–8

Abdominal Aortic Calcification and Exostoses at the Hand and Lumbar Spine: The Framingham Study

  • D. Karasik
  • D. P. Kiel
  • D. K. Kiely
  • L. A. Cupples
  • P. W. F. Wilson
  • C. J. O’Donnell
  • D. T. Felson
Clinical Investigations


Bony proliferation (exostoses) and vascular calcification are common in elderly men and women, but it is unclear whether they have a common etiology. Lateral lumbar and hand radiographs were obtained (1967–1970) in 777 men and 1,241 women (mean age 59, range 47–80 years) from the Framingham Heart Study. Each group of hand exostoses, specifically apiostoses (tufting), enthesophytes, and osteophytes, was graded on a scale of 0–3 (absent to severe) and summed across phalanges of digits 2–5. Anterior lumbar osteophytes were assessed in intervertebral spaces T12−L5 and abdominal aortic calcification (AAC) at lumbar segments L1-L4. Information on age, sex, body mass index, smoking, alcohol consumption, physical activity, systolic blood pressure, total cholesterol level, diabetes, and estrogen replacement therapy in women was obtained at the time of radiography and adjusted for in multivariate analyses. We used multivariable logistic regression models to assess the relationship between AAC (dependent variable) and exostoses for each sex. Multivariable adjusted logistic regression revealed a significant association between increased anterior lumbar osteophytes and prevalent AAC in men [odds ratio (OR) = 1.20, 95% confidence interval (CI) 1.1–1.3 per unit increase in osteophytes] and in women (OR = 1.25, 95% CI 1.1–1.4). There also was an inverse association between enthesophytes and AAC in women only (OR = 0.82, 95% CI 0.73–0.92). Apiostoses were weakly associated with AAC in men only. Hand osteophytes were not associated with AAC. In conclusion, in this cross-sectional study, anterior lumbar osteophytes and AAC occurred in the same individuals after adjustment for age and other covariates. In general, hand exostoses were not associated with aortic calcification.


Vascular calcification Exostosis Osteophyte 


  1. 1.
    Stary H, Chandler AB, Dinsmore RE, Fuster V, Glagov S, et al. (1995) A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation 92:1355–1374PubMedGoogle Scholar
  2. 2.
    Witteman J, Kok FJ, van Saase JL, Valkenburg HA (1986) Aortic calcification as a predictor of cardiovascular mortality. Lancet 2:1120–1122PubMedCrossRefGoogle Scholar
  3. 3.
    Iribarren C, Sidney S, Sternfeld B, Browner WS (2000) Calcification of the aortic arch: risk factors and association with coronary heart disease, stroke, and peripheral vascular disease. JAMA 283:2810–2815PubMedCrossRefGoogle Scholar
  4. 4.
    Blankenhorn D, Brooks SH, Selzer RH, Crawford DW, Chin HP (1974) Assessment of atherosclerosis from angiographic images. Proc Soc Exp Biol Med 145:1298–1300PubMedGoogle Scholar
  5. 5.
    Mitchell J, Adams J (1977) Aortic size and aortic calcification: a necropsy study. Atherosclerosis 27:437–446CrossRefPubMedGoogle Scholar
  6. 6.
    Eggen D, Solberg L (1986) Variation of atherosclerosis with age. Lab Invest 18:571–579Google Scholar
  7. 7.
    Kauppila LI, Polak J, Cupples LA, Hannan MT, Kiel DP, Wilson PWF (1997) New indices to classify location, severity, and progression of calcific lesions in the abdominal aorta: a 25-year follow-up study. Atherosclerosis 132:245–250CrossRefPubMedGoogle Scholar
  8. 8.
    Wilson PWF, Kauppila LI, O’Donnell C, Kiel DP, Hannan MT, Polak JM, Cupples LA (2001) Abdominal aortic calcification is an important predictor of vascular morbidity and mortality. Circulation 103:1529–1534PubMedGoogle Scholar
  9. 9.
    Walsh CR, Cupples LA, Levy D, Kiel DP, Hannan M, Wilson PW, O’Donnell CJ (2002) Abdominal aortic calcific deposits are associated with increased risk for congestive heart failure: the Framingham Heart Study. Am Heart J 144:733–739PubMedGoogle Scholar
  10. 10.
    Aigner T, Dietz U, Stoss H, Vondermark K (1995) Differential expression of collagen type-I, type-II, type-III, and type-X in human osteophytes. Lab Invest 73:236–243PubMedGoogle Scholar
  11. 11.
    Bord S, Horner A, Hembry R, Reynolds J, JE Compston (1997) Distribution of matrix metalloproteinases and their inhibitor, TIMP-1, in developing human osteophytic bone. J Anat 191:39–48CrossRefPubMedGoogle Scholar
  12. 12.
    Miyamoto S, Takaoka K, Yonenobu K, Ono K (1992) Ossification of the ligamentum-flavum induced by bone morphogenetic protein - an experimental study in mice. J Bone Joint Surg (Br) 74:279–283Google Scholar
  13. 13.
    Yonemori K, Imamura T, Ishidou Y, Okano T, Matsunaga S (1997) Bone morphogenetic protein receptors and activin receptors are highly expressed in ossified ligament tissues of patients with ossification of the posterior longitudinal ligament. Am J Pathol 150:1335–1347PubMedGoogle Scholar
  14. 14.
    Karasik D, Arensburg B, Tillier A-M, Pavlovsky O (1998) Skeletal age assessment of fossil hominids. J Archaeol Sci 25:689–696CrossRefGoogle Scholar
  15. 15.
    Jones G, Nguyen T, Sambrook PN, Kelly PJ, Eisman JA (1995) A longitudinal study of the effect of spinal degenerative disease on bone density in the elderly. J Rheumatol 22:932–936PubMedGoogle Scholar
  16. 16.
    Liu G, Peacock M, Eilam O, Dorulla G, Braunstein E, Johnston CC (1997) Effect of osteoarthritis in the lumbar spine and hip on bone mineral density and diagnosis of osteoporosis in elderly men and women. Osteoporos Int 7:564–569PubMedGoogle Scholar
  17. 17.
    O’Neill T, McCloskey EV, Kanis JA, Bhalla AK, Reeve J, et al. (1999) The distribution, determinants, and clinical correlates of vertebral osteophytosis: a population based survey. J Rheumatol 26:842–848PubMedGoogle Scholar
  18. 18.
    Weissman B (2000) Orthopedic radiology. Saunders, New YorkGoogle Scholar
  19. 19.
    Zhang Y, Niu J, Kelly-Hayes M, Chaisson CE, Aliabadi P, Felson DT (2002) Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: the Framingham Study. Am J Epidemiol 156:1021–1027CrossRefPubMedGoogle Scholar
  20. 20.
    Schulz E, Arfai K, Liu X, Sayre J, Gilsanz V (2004) Aortic calcification and the risk of osteoporosis and fractures. J Clin Endocrinol Metab 89:4246–4253CrossRefPubMedGoogle Scholar
  21. 21.
    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 68:271–276PubMedCrossRefGoogle Scholar
  22. 22.
    Boyden LM, Mao J, Belsky J, Mitzner L, Farhi A, Mitnick MA, Wu D, Insogna K, Lifton RP (2002) High bone density due to a mutation in LDL-receptor-related protein 5. N Engl J Med 346:1513–1521CrossRefPubMedGoogle Scholar
  23. 23.
    Dequeker J, Aerssens J, Luyten FP (2003) Osteoarthritis and osteoporosis: clinical and research evidence of inverse relationship. Aging Clin Exp Res 15:426–439PubMedGoogle Scholar
  24. 24.
    Rogers J, Shepstone L, Dieppe P (1997) Bone formers: osteophyte and enthesophyte formation are positively associated. Ann Rheum Dis 56:85–90PubMedCrossRefGoogle Scholar
  25. 25.
    Demer L, Watson K, Bostrom K (1994) Mechanism of calcification in atherosclerosis. Trends Cardiovasc Med 4:45–49CrossRefGoogle Scholar
  26. 26.
    Lane N, Nevitt M, Genant H, Hochberg M (1993) Reliability of new indices of radiographic osteoarthritis of the hand and hip and lumbar disc degeneration. J Rheumatol 20:1911–1918PubMedGoogle Scholar
  27. 27.
    Kauppila LI, McAlindon T, Evans S, Wilson PW, Kiel D, Felson DT (1997) Disc degeneration/back pain and calcification of the abdominal aorta. A 25-year follow-up study in Framingham. Spine 22:1642–1649CrossRefPubMedGoogle Scholar
  28. 28.
    Kricun M, Edeiken J (1973) Atlas of hand bones in systemic disease. Williams & Wilkins, BaltimoreGoogle Scholar
  29. 29.
    Kellgren J, Lawrence JS (1957) Radiologic assessment of osteoartrosis. Ann Rheum Dis 16:494–501PubMedGoogle Scholar
  30. 30.
    Altman R, Hochberg M, Murphy WJ, Wolfe F, Lequesne M (1995) Atlas of individual radiographic features in osteoarthritis. Osteoarthritis Cartilage (suppl A):3–70PubMedGoogle Scholar
  31. 31.
    Kallman D, Wigley F, Scott W, Hochberg M, Tobin J (1989) New radiographic grading scales for osteoarthritis of the hand. Arthritis Rheum 32:1584–1591PubMedGoogle Scholar
  32. 32.
    Pavlovsky O, Kobyliansky E (1999) Population biology of human aging. Angelo Pontecorboli Press, FlorenceGoogle Scholar
  33. 33.
    Karasik D, Yakovenko K, Barakh I, Kobyliansky E, Livshits G, Batsevich V, Otremski I, Pavlovsky O (1999) Comparative analysis of age prediction by markers of bone change in the hand as assessed by roentgenography. Am J Hum Biol 11:31–44CrossRefPubMedGoogle Scholar
  34. 34.
    Felson DT, Kiel DP, Anderson JJ, Kannel WB (1988) Alcohol consumption and hip fractures: the Framingham Study. Am J Epidemiol 128:1102–1110PubMedGoogle Scholar
  35. 35.
    Kannel WB, Sorlie P (1979) Some health benefits of physical activity. The Framingham Study. Arch Intern Med 139:857–861CrossRefPubMedGoogle Scholar
  36. 36.
    Kiely DK, Wolf PA, Cupples LA, Beiser AS, Kannel WB (1994) Physical activity and stroke risk: the Framingham Study. Am J Epidemiol 140:608–620PubMedGoogle Scholar
  37. 37.
    Samelson EJ, Kiel DP, Broe KE, Zhang Y, Cupples LA, Hannan MT, Wilson PW, Levy D, Williams SA, Vaccarino V (2004) Metacarpal cortical area and risk of coronary heart disease: the Framingham Study. Am J Epidemiol 159:589–595CrossRefPubMedGoogle Scholar
  38. 38.
    Agresti A (1990) Categorical data analysis. John Wiley & Sons, New YorkGoogle Scholar
  39. 39.
    Hak A, Pols H, van Hemert A, Hofman A, Witteman J (2000) Progression of aortic calcification is associated with metacarpal bone loss during menopause: a population-based longitudinal study. Arterioscler Thromb Vasc Biol 20:1926–1931PubMedGoogle Scholar
  40. 40.
    Pye SR, Reid DM, Smith R, Adams JE, Nelson K, Silman AJ, O’Neill TW (2004) Radiographic features of lumbar disc degeneration and self-reported back pain. J Rheumatol 31:753–758PubMedGoogle Scholar
  41. 41.
    Chaisson CE, Zhang Y, McAlindon TE, Hannan MT, Aliabadi P, Naimark A, Levy D, Felson DT (1997) Radiographic hand osteoarthritis: incidence, patterns, and influence of pre-existing disease in a population based sample. J Rheumatol 24:1337–1343PubMedGoogle Scholar
  42. 42.
    Kauppila LI, Mikkonen R, Mankinen P, Pelto-Vasenius K, Maenpaa I (2004) MR aortography and serum cholesterol levels in patients with long-term nonspecific lower back pain. Spine 29:2147–2152PubMedCrossRefGoogle Scholar
  43. 43.
    Walsh DA (2004) Angiogenesis in osteoarthritis and spondylosis: successful repair with undesirable outcomes. Curr Opin Rheumatol 16:609–615PubMedCrossRefGoogle Scholar
  44. 44.
    Koki A, Khan NK, Woerner BM, Dannenberg AJ, Olson L, Seibert K, Edwards D, Hardy M, Isakson P, Masferrer JL (2002) Cyclooxygenase-2 in human pathological disease. Adv Exp Med Biol 507:177–184PubMedGoogle Scholar
  45. 45.
    Valdes A, Hassett G, Hart D, Spector T (2005) Radiographic progression of lumbar spine disc degeneration is influenced by variation at inflammatory genes: a candidate SNP association study in the Chingford cohort. Spine 30(21):2445–2451CrossRefPubMedGoogle Scholar
  46. 46.
    Rogers J, Shepstone L, Dieppe P (2004) Is osteoarthritis a systemic disorder of bone? Arthritis Rheum 50:452–457CrossRefPubMedGoogle Scholar
  47. 47.
    Felson DT, Neogi T (2004) Osteoarthritis: is it a disease of cartilage or of bone? Arthritis Rheum 50:341–344PubMedCrossRefGoogle Scholar
  48. 48.
    Voudouris KP (2003) Enthesial fibrocartilage-bone interaction. J Musculoskel Neuron Interact 3:89–100Google Scholar
  49. 49.
    Sarzi-Puttini P, Atzeni F (2004) New developments in our understanding of DISH (diffuse idiopathic skeletal hyperostosis). Curr Opin Rheumatol 16:287–292PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • D. Karasik
    • 1
  • D. P. Kiel
    • 1
  • D. K. Kiely
    • 1
  • L. A. Cupples
    • 2
  • P. W. F. Wilson
    • 3
  • C. J. O’Donnell
    • 4
  • D. T. Felson
    • 5
  1. 1.Hebrew SeniorLife and Harvard Medical SchoolBostonUSA
  2. 2.Department of BiostatisticsBoston University School of Public HealthBostonUSA
  3. 3.Department of Endocrinology, Diabetes, and Medical GeneticsMedical University of South CarolinaCharlestonUSA
  4. 4.NHLBI, Framingham Heart StudyFraminghamUSA
  5. 5.Department of Clinical EpidemiologyBoston University School of MedicineBostonUSA

Personalised recommendations