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Associations between hip bone mineral density, aortic calcification and cardiac workload in community-dwelling older
A J Rodríguez1, D Scott2,3,4, A Hodge5,6
1Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3146, Australia. alexander.rodriguez@monash.edu.
Insights
Lower bone density in older adults is linked to increased heart workload, especially in women. This association is partly explained by aortic calcification, suggesting higher cardiovascular risk for those with osteoporosis.
Area of Science:
- Gerontology
- Cardiology
- Orthopedics
Background:
- Osteoporosis and cardiovascular disease are common in older adults.
- Bone mineral density (BMD) and aortic calcification (AAC) are potential indicators of cardiovascular risk.
Purpose of the Study:
- To investigate the association between lower BMD and increased cardiac workload in older adults.
- To determine if this association is independent of abdominal aortic calcification (AAC).
Main Methods:
- 337 older adults (mean age 70 years, 61% female) underwent BMD and AAC assessments.
- Cardiac workload was measured using the rate pressure product (RPP = BP x HR).
- Multivariate regression analyses were performed, including sex-stratified analyses.
Main Results:
- Aortic calcification score (ACS) was positively associated with RPP in all participants, particularly in females.
- Lower femoral neck BMD was associated with lower odds of AAC.
- Lower BMD at the femoral neck and total hip was inversely associated with RPP, with a partial mediation by AAC.
Conclusions:
- Lower BMD is associated with increased cardiac workload in older adults, an effect partially mediated by AAC.
- This suggests that individuals with osteoporosis, particularly women, may face elevated cardiovascular risk.
- The findings highlight the interconnectedness of bone health and cardiovascular health in aging populations.
Abstract:
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.