Osteoporosis International

, Volume 16, Issue 12, pp 2053–2062 | Cite as

Relationship between bone mineral density and myocardial infarction in US adults

  • Jeanette H. Magnus
  • Danielle L. Broussard
Original Article


Cardiovascular disease and osteoporosis have several common risk factors, and quite a few studies suggest a relationship between them. The objective of the present study was to explore the relationship between cardiovascular disease risk factors and bone mineral density in association with having had a previous myocardial infarction in a general population. This cross-sectional study was conducted using data for 5,050 women and men aged 50–79 years who participated in the Third National Health and Nutrition Examination Survey (NHANES III). Race/ethnic and gender-specific mean BMD values for young adults were used to determine race/ethnic and gender-specific T -scores to define osteoporosis and low BMD. Multiple logistic regression analysis revealed that subjects self-reporting a previous myocardial infarction had significantly higher odds (odds ratio 1.28, [95% confidence interval (CI), 1.01 to 1.63] p =0.04) of having low bone mineral density, when adjusting for cardiovascular disease and osteoporosis risk factors. Self-reported myocardial infarction was not significantly associated with low bone mineral density in women, (odds ratio 1.22, [95% CI, 0.80 to 1.86] p =0.37), but was significant in men, (odds ratio 1.39, [95% CI, 1.03 to 1.87] p =0.03). These findings demonstrate that male survivors of myocardial infarction have low bone mineral density. The pathophysiologic connection between the atherosclerotic and the osteoporotic processes needs further elucidation. It is also of importance to study the processes in both men and women.


Bone mineral density Gender Myocardial infarction Race/ethnicity Risk factors 


  1. 1.
    Johansson C, Black D, Johnell O, Oden A, Mellstrom D (1998) Bone mineral density is a predictor of survival. Calcif Tissue Int 63:190–196CrossRefPubMedGoogle Scholar
  2. 2.
    von der Recke P, Hansen MA, Hassager C (1999) The association between low bone mass at the menopause and cardiovascular mortality. Am J Med 106:273–278CrossRefPubMedGoogle Scholar
  3. 3.
    Mussolino ME, Madans JH, Gillum RF (2003) Bone mineral density and mortality in women and men: the NHANES I Epidemiologic Follow-up Study. Ann Epidemiol 13:692–697CrossRefPubMedGoogle Scholar
  4. 4.
    Trivedi DP, Khaw KT (2001) Bone mineral density at the hip predicts mortality in elderly men. Osteoporos Int 12:259–265CrossRefPubMedGoogle Scholar
  5. 5.
    Van Der Klift M, Pols HA, Geleijnse JM, Van Der Kuip DA, Hofman A, De Laet CE (2002) Bone mineral density and mortality in elderly men and women: the Rotterdam Study. Bone 30:643–648CrossRefPubMedGoogle Scholar
  6. 6.
    Mosca L, Manson JE, Sutherland SE, Langer RD, Manolio T, Barrett-Connor E (1997) Cardiovascular disease in women: a statement for healthcare professionals from the American Heart Association. Writing Group. Circulation 96:2468–2482PubMedGoogle Scholar
  7. 7.
    McFarlane SI, Muniyappa R, Shin JJ, Bahtiyar G, Sowers JR (2004) Osteoporosis and cardiovascular disease: brittle bones and boned arteries. Is there a link? Endocrine 23:1–10CrossRefPubMedGoogle Scholar
  8. 8.
    Alagiakrishnan K, Juby A, Hanley D, Tymchak W, Sclater A (2003) Role of vascular factors in osteoporosis. J Gerontol A Biol Sci Med Sci 58:362–366PubMedGoogle Scholar
  9. 9.
    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 73:15–20CrossRefPubMedGoogle Scholar
  10. 10.
    Jorgensen L, Engstad T, Jacobsen BK (2001) Bone mineral density in acute stroke patients: low bone mineral density may predict first stroke in women. Stroke 32:47–51PubMedGoogle Scholar
  11. 11.
    National Center for Health Statistics (1994) Plan and operation of the Third National Health and Nutrition Examination Survey, 1988–1994. Vital Health Stat 1(32). DHHS publication No. (PHS) 94-1308. NCHS, Hyattsville, MD, USAGoogle Scholar
  12. 12.
    Chen Z, Kooperberg C, Pettinger MB, Bassford T, Cauley JA, LaCroix AZ et al (2004) Validity of self-report for fractures among a multiethnic cohort of postmenopausal women: results from the Women’s Health Initiative observational study and clinical trials. Menopause 11:264–274CrossRefPubMedGoogle Scholar
  13. 13.
    Bergmann MM, Byers T, Freedman DS, Mokdad A (1998) Validity of self-reported diagnoses leading to hospitalization: a comparison of self-reports with hospital records in a prospective study of American adults. Am J Epidemiol 147:969–977PubMedGoogle Scholar
  14. 14.
    O’Mahony PG, Dobson R, Rodgers H, James OF, Thomson RG (1995) Validation of a population screening questionnaire to assess prevalence of stroke. Stroke 26:1334–1337PubMedGoogle Scholar
  15. 15.
    Caraballo RS, Giovino GA, Pechacek TF, Mowery PD (2001) Factors associated with discrepancies between self-reports on cigarette smoking and measured serum cotinine levels among persons aged 17 years or older: Third National Health and Nutrition Examination Survey, 1988–1994. Am J Epidemiol 153:807–814CrossRefPubMedGoogle Scholar
  16. 16.
    National Center for Health Statistics (1996) NHANES III reference manuals and reports (CD-ROM). Centers for Disease Control and Prevention, Hyattsville, MD, USAGoogle Scholar
  17. 17.
    Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP et al (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–489CrossRefPubMedGoogle Scholar
  18. 18.
    Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141PubMedGoogle Scholar
  19. 19.
    de Laet CE, van der Klift M, Hofman A, Pols HA (2002) Osteoporosis in men and women: A story about bone mineral density thresholds and hip fracture risk. J Bone Miner Res 17:2231–2236PubMedGoogle Scholar
  20. 20.
    Broussard DL, Magnus JH (2004) Risk assessment and screening for low bone mineral density in a multi-ethnic population of women and men: Does one approach fit all? Osteoporos Int 15:349–360CrossRefPubMedGoogle Scholar
  21. 21.
    Adami S, Braga V, Zamboni M, Gatti D, Rossini M, Bakri J et al (2004) Relationship between lipids and bone mass in 2 cohorts of healthy women and men. Calcif Tissue Int 74:136–142CrossRefPubMedGoogle Scholar
  22. 22.
    Cappuccio FP, Meilahn E, Zmuda JM, Cauley JA (1999) High blood pressure and bone-mineral loss in elderly white women: a prospective study. Study of Osteoporotic Fractures Research Group. Lancet 354:971–975CrossRefPubMedGoogle Scholar
  23. 23.
    Jankowska EA, Susanne C, Rogucka E, Medras M (2002) The inverse relationship between bone status and blood pressure among Polish men. Ann Hum Biol 29:63–73CrossRefPubMedGoogle Scholar
  24. 24.
    Browner WS, Seeley DG, Vogt TM, Cummings SR (1991) Non-trauma mortality in elderly women with low bone mineral density. Study of Osteoporotic Fractures Research Group. Lancet 338:355–358CrossRefPubMedGoogle Scholar
  25. 25.
    Browner WS, Pressman AR, Nevitt MC, Cauley JA, Cummings SR (1993) Association between low bone density and stroke in elderly women. The study of osteoporotic fractures. Stroke 24:940–946PubMedGoogle Scholar
  26. 26.
    Kado DM, Browner WS, Blackwell T, Gore R, Cummings SR (2000) Rate of bone loss is associated with mortality in older women: a prospective study. J Bone Miner Res 15:1974–1980PubMedGoogle Scholar
  27. 27.
    National Osteoporosis Foundation (1999) Physician’s guide to prevention and treatment of osteoporosis. Excerpta Medica, New Jersey, USAGoogle Scholar
  28. 28.
    Nelson HD, Helfand M, Woolf SH, Allan JD (2002) Screening for postmenopausal osteoporosis: a review of the evidence for the US Preventive Services Task Force. Ann Intern Med 137:529–541PubMedGoogle Scholar
  29. 29.
    Guerci AD, Spadaro LA, Goodman KJ, Lledo-Perez A, Newstein D, Lerner G et al (1998) Comparison of electron beam computed tomography scanning and conventional risk factor assessment for the prediction of angiographic coronary artery disease. J Am Coll Cardiol 32:673–679CrossRefPubMedGoogle Scholar
  30. 30.
    Demer LL (2002) Vascular calcification and osteoporosis: inflammatory responses to oxidized lipids. Int J Epidemiol 31:737–741CrossRefPubMedGoogle Scholar
  31. 31.
    Bostrom K (2001) Insights into the mechanism of vascular calcification. Am J Cardiol 88:20E–22ECrossRefPubMedGoogle Scholar
  32. 32.
    Parhami F, Garfinkel A, Demer LL (2000) Role of lipids in osteoporosis. Arterioscler Thromb Vasc Biol 20:2346–2348PubMedGoogle Scholar
  33. 33.
    Wilson PW, Kauppila LI, O’Donnell CJ, Kiel DP, Hannan M, Polak JM et al (2001) Abdominal aortic calcific deposits are an important predictor of vascular morbidity and mortality. Circulation 103:1529–1534PubMedGoogle Scholar
  34. 34.
    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 283:2810–2815CrossRefPubMedGoogle Scholar
  35. 35.
    Keelan PC, Bielak LF, Ashai K, Jamjoum LS, Denktas AE, Rumberger JA et al (2001) Long-term prognostic value of coronary calcification detected by electron-beam computed tomography in patients undergoing coronary angiography. Circulation 104:412–417PubMedGoogle Scholar
  36. 36.
    Banks LM, Lees B, MacSweeney JE, Stevenson JC (1994) Effect of degenerative spinal and aortic calcification on bone density measurements in post-menopausal women: links between osteoporosis and cardiovascular disease? Eur J Clin Invest 24:813–817PubMedGoogle Scholar
  37. 37.
    Barengolts EI, Berman M, Kukreja SC, Kouznetsova T, Lin C, Chomka EV (1998) Osteoporosis and coronary atherosclerosis in asymptomatic postmenopausal women. Calcif Tissue Int 62:209–213CrossRefPubMedGoogle Scholar
  38. 38.
    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 20:1926–1931PubMedGoogle Scholar
  39. 39.
    Jie KG, Bots ML, Vermeer C, Witteman JC, Grobbee DE (1996) Vitamin K status and bone mass in women with and without aortic atherosclerosis: a population-based study. Calcif Tissue Int 59:352–356CrossRefPubMedGoogle Scholar
  40. 40.
    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 68:271–276PubMedGoogle Scholar
  41. 41.
    Sugihara N, Matsuzaki M (1993) The influence of severe bone loss on mitral annular calcification in postmenopausal osteoporosis of elderly Japanese women. Jpn Circ J 57:14–26PubMedGoogle Scholar
  42. 42.
    Aoyagi K, Ross PD, Orloff J, Davis JW, Katagiri H, Wasnich RD (2001) Low bone density is not associated with aortic calcification. Calcif Tissue Int 69:20–24CrossRefPubMedGoogle Scholar
  43. 43.
    Drinka PJ, Bauwens SF, DeSmet AA (1992) Lack of correlation between aortic calcification and bone density. Wis Med J 91:299–301PubMedGoogle Scholar
  44. 44.
    Frye MA, Melton LJ 3rd, Bryant SC, Fitzpatrick LA, Wahner HW, Schwartz RS et al (1992) Osteoporosis and calcification of the aorta. Bone Miner 19:185–194CrossRefPubMedGoogle Scholar
  45. 45.
    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
  46. 46.
    Uyama O, Yoshimoto Y, Yamamoto Y, Kawai A (1997) Bone changes and carotid atherosclerosis in postmenopausal women. Stroke 28:1730–1732PubMedGoogle Scholar
  47. 47.
    van der Klift M, Pols HA, Hak AE, Witteman JC, Hofman A, de Laet CE (2002) Bone mineral density and the risk of peripheral arterial disease: the Rotterdam Study. Calcif Tissue Int 70:443–449CrossRefPubMedGoogle Scholar
  48. 48.
    Pennisi P, Signorelli SS, Riccobene S, Celotta G, Di Pino L, La Malfa T et al (2004) Low bone density and abnormal bone turnover in patients with atherosclerosis of peripheral vessels. Osteoporos Int 15:389–395CrossRefPubMedGoogle Scholar
  49. 49.
    Qureshi AI, Suri MF, Kirmani JF, Divani AA (2004) The relative impact of inadequate primary and secondary prevention on cardiovascular mortality in the United States. Stroke 35:2346–2350CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005

Authors and Affiliations

  1. 1.Tulane University Health Sciences CenterSchool of Public Health and Tropical MedicineNew OrleansUSA

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