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Associations between bone mineral density and coronary artery disease: a meta-analysis of cross-sectional studies

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Abstract

Summary

A meta-analysis was performed to explore the association of coronary artery disease (CAD) with bone mineral density (BMD). Low BMD was not found to be associated with prevalence of CAD. Though the BMD of CADs is significantly lower than that of non-CADs, the confounding effect of aging could not be excluded as CADs might be more prevalent in older patients.

Purpose/introduction

The clinical association of coronary artery disease (CAD) with bone mineral density (BMD) has been increasingly reported, but findings on the relationship between the two age-related processes are conflicting. The aim of our study was to conduct a meta-analysis to evaluate the associations between CAD and BMD.

Methods

We searched PubMed, Embase, and Cochrane Library. Odds ratio (OR) and 95% confidence interval (CI) were pooled to assess the association between low BMD and the prevalence of CAD. For continuous data, standardized mean difference (SMD) with its 95% CI was pooled. Correlation coefficients of BMD and Gensini score were pooled after being transformed by Fischer z-transformation. Subgroup and meta-regression analyses were performed to explore the sources of heterogeneity.

Results

The meta-analysis involved 4170 participants from 11 studies. Pooled ORs for the incidence of CAD in patients with low BMD versus patients with normal BMD was 1.58 (95% CI 0.99–2.52, P = 0.06), and no statistical difference was found in men and women subgroups. After confounding age, the combined OR was 1.60 (95% OR 0.69–3.72, P = 0.27). Pooling data for comparing BMD of CADs and non-CADs were − 0.28 (95% CI − 0.47 to − 0.09, P = 0.004) in femoral neck and calcaneus, − 0.42 (95% CI − 0.89–0.05, P = 0.08) in lumbar spine, and − 0.25 (95% CI − 0.40 to − 0.11, P = 0.000) in the overall. A significance was detected in pooled correlation analysis between CAG Gensini score and BMD (COR = − 0.4435 [− 0.6647; − 0.1508], P = 0.004). No sources of heterogeneity were acquired, and no publication bias was identified.

Conclusions

Low BMD was not associated with the prevalence of CAD. Without age adjustment, the BMD of CADs is significantly lower than that of non-CADs, and the patients with lower BMD are inclined to more severe coronary artery lesions.

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Abbreviations

BMD:

Bone mineral density

CAD:

Coronary artery disease

CAG:

Coronary angiography

CI:

Confidence interval

DXA:

Dual-energy X-ray absorptiometry

NOS:

Newcastle-Ottawa Scale

OR:

Odds ratio

SMD:

Standardized mean difference

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

QUS:

Quantitative ultrasound

WHO:

World Health Organization

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Funding

This work was supported by a grant from a project supported by the National Natural Science Foundation of China (81503627), First-class Discipline Open Fund of Chinese Medicine (2018ZYX02), and Scientific Research Project of Hunan Provincial Department of Education (18K070).

Author information

Author notes

  1. Yonghui Zhang and Bing He contributed equally to this work.

Authors and Affiliations

  1. Orthopaedics Department, Luohe Central Hospital, Luohe, 462000, Henan, People’s Republic of China

    Yonghui Zhang, Bing He, Haijiao Wang & Jianwei Shi

  2. Institute of TCM Diagnostics, Hunan University of Chinese Medicine, 300 Xueshi Rd, Science-Education Industrial Park, Yuelu Region, Changsha, 410208, Hunan, People’s Republic of China

    Hao Liang

  3. Hunan Provincial Key laboratory of TCM Diagnostics, Hunan University of Chinese Medicine, 300 Xueshi Rd, Science-Education Industrial Park, Yuelu Region, Changsha, 410208, Hunan, People’s Republic of China

    Hao Liang

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  1. Yonghui Zhang
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Contributions

Hao Liang conceived and designed the research. Hao Liang and Yonghui Zhang performed the statistical analysis. Hao Liang drafted the manuscript. Bing He and Yonghui Zhang made the critical revision of the manuscript in key intellectual content. Bing He and Haijiao Wang acquired the data and performed the methodological quality assessment.

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Correspondence to Hao Liang.

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Zhang, Y., He, B., Wang, H. et al. Associations between bone mineral density and coronary artery disease: a meta-analysis of cross-sectional studies. Arch Osteoporos 15, 24 (2020). https://doi.org/10.1007/s11657-020-0691-1

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