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Relationship Between Low Bone Mineral Density and Fractures With Incident Cardiovascular Disease: A Systematic Review
Nicola Veronese1,2, Brendon Stubbs3,4,5, Gaetano Crepaldi2
1Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy.
Insights
Low bone mineral density (BMD) and fractures increase cardiovascular disease (CVD) risk. This meta-analysis confirms low BMD and fractures are significant risk factors for future CVD events and mortality.
Area of Science:
- Cardiology
- Endocrinology
- Epidemiology
Background:
- Growing evidence links low bone mineral density (BMD) and fractures with cardiovascular disease (CVD).
- Understanding this association is crucial for comprehensive risk assessment and patient management.
Purpose of the Study:
- To systematically review and meta-analyze the evidence on low BMD and fractures as predictors of future CVD.
- To quantify the association between low BMD, fractures, and CVD incidence.
Main Methods:
- Systematic review and random-effects meta-analysis of longitudinal studies.
- Searched major databases for studies reporting CVD incidence and BMD status or fractures.
- Pooled adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated.
Main Results:
- Low BMD was associated with increased CVD risk (HR=1.33) and a 1.16 HR per standard deviation decrease.
- Fractures at baseline were linked to a 1.20 HR for developing CVD.
- Low BMD predicted coronary artery disease, cerebrovascular conditions, and CVD death; fractures predicted cerebrovascular events and CVD death.
Conclusions:
- Low BMD and fractures represent significant, albeit small, increased risks for cardiovascular disease and mortality.
- These findings highlight the interconnectedness of bone health and cardiovascular health.
Abstract:
An increasing evidence base suggests that low bone mineral density (BMD) and fractures are associated with cardiovascular disease (CVD). We conducted a systematic review and meta-analysis summarizing the evidence of low BMD and fractures as risk factors for future CVD. Two independent authors searched major databases from inception to August 1, 2016, for longitudinal studies reporting data on CVD incidence (overall and specific CVD) and BMD status and fractures. The association between low BMD, fractures, and CVD across longitudinal studies was explored by calculating pooled adjusted hazard ratios (HRs) ±95% confidence intervals (CIs) with a random-effects meta-analysis. Twenty-eight studies (18 regarding BMD and 10 fractures) followed a total of 1,107,885 participants for a median of 5 years. Taking those with higher BMD as the reference, people with low BMD were at increased risk of developing CVD during follow-up (11 studies; HR = 1.33; 95%CI, 1.27 to 1.38; I2 = 53%), after adjusting for a median of eight confounders. This finding was confirmed using a decrease in one standard deviation of baseline BMD (9 studies; HR = 1.16; 95% CI, 1.09 to 1.24; I2 = 69%). The presence of fractures at baseline was associated with an increased risk of developing CVD (HR = 1.20; 95% CI, 1.06 to 1.37; I2 = 91%). Regarding specific CVDs, low BMD was associated with an increased risk of developing coronary artery disease, cerebrovascular conditions, and CVD-associated death. Fractures at baseline was associated with an increased risk of cerebrovascular conditions and death due to CVD. In conclusion, low BMD and fractures are associated with a small, but significant increased risk of CVD risk and possibly death. © 2017 American Society for Bone and Mineral Research.
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