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Poor Bone Quality is Associated With Greater Arterial Stiffness: Insights From the UK Biobank
Zahra Raisi-Estabragh1,2, Luca Biasiolli3, Jackie Cooper1,2
1William Harvey Research Institute, National Institute for Health Research (NIHR) Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, UK.
Insights
Higher bone density, measured by bone speed of sound (SOS), is linked to better vascular health and lower risk of ischemic heart disease (IHD) mortality, especially in men. Underlying mechanisms are complex and sex-specific.
Area of Science:
- Bone and Mineral Research
- Cardiovascular Disease
- Public Health
Background:
- Osteoporosis and ischemic heart disease (IHD) are significant public health concerns.
- Research suggests a potential causal link between osteoporosis and IHD beyond shared risk factors.
Purpose of the Study:
- To investigate the association between bone speed of sound (SOS) and measures of arterial compliance (aortic distensibility [AD] and arterial stiffness index [ASI]).
- To examine the relationship between SOS and incident myocardial infarction and IHD mortality.
- To explore potential mediating effects of biomarkers and comorbidities, and differential relationships by sex and other factors.
Main Methods:
- Utilized quantitative heel ultrasound for bone speed of sound (SOS) measurements.
- Assessed arterial compliance using cardiovascular magnetic resonance (aortic distensibility [AD]) and finger photoplethysmography (arterial stiffness index [ASI]).
- Analyzed data from the UK Biobank cohort, considering mediating factors and subgroup differences.
Main Results:
- Higher SOS was associated with lower arterial compliance (both AD and ASI) in men and women.
- Blood biomarkers partially mediated the association, with sex-specific effects.
- Higher SOS showed a significant association with lower IHD mortality in men, and a less robust association in women.
Conclusions:
- Findings support a positive association between bone health and vascular health.
- The underlying mechanisms are complex and appear to differ between sexes.
- Bone health may be a relevant factor in assessing cardiovascular risk.
Abstract:
Osteoporosis and ischemic heart disease (IHD) represent important public health problems. Existing research suggests an association between the two conditions beyond that attributable to shared risk factors, with a potentially causal relationship. In this study, we tested the association of bone speed of sound (SOS) from quantitative heel ultrasound with (i) measures of arterial compliance from cardiovascular magnetic resonance (aortic distensibility [AD]); (ii) finger photoplethysmography (arterial stiffness index [ASI]); and (iii) incident myocardial infarction and IHD mortality in the UK Biobank cohort. We considered the potential mediating effect of a range of blood biomarkers and cardiometabolic morbidities and evaluated differential relationships by sex, menopause status, smoking, diabetes, and obesity. Furthermore, we considered whether associations with arterial compliance explained association of SOS with ischemic cardiovascular outcomes. Higher SOS was associated with lower arterial compliance by both ASI and AD for both men and women. The relationship was most consistent with ASI, likely relating to larger sample size available for this variable (n = 159,542 versus n = 18,229). There was no clear evidence of differential relationship by menopause, smoking, diabetes, or body mass index (BMI). Blood biomarkers appeared important in mediating the association for both men and women, but with different directions of effect and did not fully explain the observed effects. In fully adjusted models, higher SOS was associated with significantly lower IHD mortality in men, but less robustly in women. The association of SOS with ASI did not explain this observation. In conclusion, our findings support a positive association between bone and vascular health with consistent patterns of association in men and women. The underlying mechanisms are complex and appear to vary by sex. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).