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Author Spotlight: An Economic and Efficient Method for Quantitative Evaluation of Bone Microarchitecture in a Murine Osteoporosis Model
Published on: September 8, 2023
Association of bone mineral density and trabecular bone score with cardiovascular disease
Tzyy-Ling Chuang1,2, Mei-Hua Chuang3,4, Malcolm Koo5
1Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
Insights
Osteoporosis and cardiovascular disease are linked. Lower bone mineral density (BMD) correlates with higher coronary artery calcification (CAC), suggesting shared risk factors and potential for early intervention using BMD and FRAX® assessment.
Area of Science:
- Cardiovascular Medicine
- Bone Biology
- Radiology
Background:
- Osteoporosis and cardiovascular disease (CVD) were traditionally viewed as distinct. Emerging research highlights connections between osteoporosis and conditions like hypertension, dyslipidemia, atherosclerosis, vascular calcification (VC), and heart failure.
- Vascular calcification (VC) frequently co-occurs with bone loss; aortic calcification predicts low bone mineral density (BMD) and fractures. Similarly, coronary artery calcification (CAC) severity is inversely related to BMD.
Purpose of the Study:
- To review the relationship and potential mechanisms linking bone mineral density (BMD), trabecular bone score (TBS), and FRAX® with cardiovascular disease (CVD), vascular calcification (VC), and coronary artery calcification (CAC).
Main Methods:
- Utilizing trabecular bone score (TBS) iNsight software to analyze bone microstructure from BMD databases.
- Reviewing studies on TBS in relation to fracture risk, aging, diabetes, genetics, obesity, and asthma.
- Examining the association between FRAX® (fracture risk assessment tool) and coronary artery calcification (CAC) scores.
- Discussing the use of dual-energy X-ray absorptiometry (DXA) and FRAX® in predicting fracture risk and CAC.
Main Results:
- A higher TBS is linked to moderate, but not severe, CAC, potentially indicating active bone remodeling during early coronary calcification.
- Increased 10-year fracture risk, as estimated by FRAX®, is independently associated with more severe CAC.
- The inverse relationship between TBS and VC may offer insights into bone-vascular interactions in chronic kidney disease.
Conclusions:
- Shared pathways may link bone and vascular health, suggesting that BMD, TBS, and FRAX® assessments can identify patients at risk for both fractures and CVD.
- Early intervention strategies can be developed by integrating fracture risk assessment tools like FRAX® with cardiovascular risk evaluation.
- Further research into the bone-vascular interplay is crucial for comprehensive patient management.
Abstract:
Traditionally, osteoporosis and cardiovascular disease (CVD) are considered as separate chronic diseases. Increasing evidence now links osteoporosis with hypertension, abnormal lipid metabolism, atherosclerosis, vascular calcification (VC), and congestive heart failure. VC coexists with bone loss, and aortic calcification is a strong predictor of low bone mineral density (BMD) and fragility fractures. The same holds true for coronary artery calcification (CAC): the lower the BMD, the higher the CAC. Trabecular bone score (TBS) iNsight software can analyze the existing BMD database to obtain the bony microstructure score (TBS). Many TBS-related studies include fracture risk, normal aging, diabetes, potential genes, obesity, and asthma severity prediction. The inverse relationship of TBS to VC may provide insight into bone-vascular interactions in chronic kidney disease. A higher TBS has been associated with moderate, but not high, CAC. One explanation is that bone microstructural remodeling becomes more active during early coronary calcification. Increased risk of 10-year likelihood of hip fracture and major osteoporotic fracture as estimated by the fracture risk assessment tool FRAX® is significantly and independently associated with more severe CAC scores. Dual-energy X-ray absorptiometry and FRAX® can be used to predict fracture risk and CAC scores, identifying patients who may benefit from early intervention. This review will discuss the relationship and possible mechanism of BMD, TBS, and FRAX® with CVD and VC or CAC.
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