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High Cardiovascular Risk in Older Men with Poor Bone Microarchitecture-The Prospective STRAMBO Study
Pawel Szulc1, Dominique Foesser1, Roland Chapurlat1
1INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.
Insights
In older men, better bone health, including higher bone mineral density and stronger bone microarchitecture, is linked to a reduced risk of major adverse coronary events (MACE). This suggests bone health is an important indicator for cardiovascular disease risk.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Bone Biology
Background:
- Data linking bone microarchitecture to cardiovascular disease (CVD) in men is limited.
- Older men are at increased risk for both bone-related issues and CVD.
Purpose of the Study:
- To investigate the association between bone microarchitecture, areal bone mineral density (aBMD), and the risk of major adverse coronary events (MACE) in older men.
- To determine if bone health metrics can predict cardiovascular risk in aging males.
Main Methods:
- Prospective cohort study of men aged 60-87 years, followed for 8 years.
- Bone microarchitecture assessed via high-resolution peripheral quantitative computed tomography (XtremeCT).
- Areal bone mineral density (aBMD) measured using a Hologic Discovery-A device.
Main Results:
- Higher aBMD at multiple sites (spine, hip, whole body, radius) was associated with a lower risk of MACE.
- Improved cortical bone density and thickness at the distal radius and tibia correlated with reduced MACE risk.
- Greater estimated bone strength (stiffness, failure load) was significantly linked to a lower incidence of MACE.
Conclusions:
- In older men, higher aBMD, preserved cortical bone status, and increased estimated bone strength are associated with a lower risk of MACE.
- Bone health parameters may serve as valuable indicators for cardiovascular risk assessment in aging men.
- These findings highlight the interconnectedness of skeletal and cardiovascular health in older populations.
Abstract:
Data on the association between bone microarchitecture and cardiovascular disease (CVD) in men are scarce. We studied the link of bone microarchitecture and areal bone mineral density (aBMD) with the risk of major adverse coronary event (MACE) in a cohort of men aged 60 to 87 years followed prospectively for 8 years. At baseline, aBMD was measured using a Hologic Discovery-A device. Bone microarchitecture was assessed at distal radius and tibia by high-resolution peripheral quantitative computed tomography (XtremeCT Scanco device). During the study, 53 men had incident MACE. The analyses were adjusted for confounders related to bone and CVD. In 813 men (53 MACEs), higher aBMD at the lumbar spine, hip, whole body, and radius was associated with lower risk of MACE (hazard ratio [HR] = 0.44-0.71/SD, p < .025 to < .001). In 745 men having valid distal radius scan (47 MACEs), higher cortical density (Ct.BMD) and higher cortical thickness (Ct.Thd ) were associated with lower risk of MACE. This risk was higher in men in the lowest quintile of cortical measures versus the four upper quintiles combined (Ct.BMD: HR = 2.12, 95% confidence interval [CI] 1.08-4.17, p < .025). Findings were similar in 779 men having valid distal tibia scan (48 MACEs). At both sites, higher estimated stiffness and higher failure load were associated with a lower risk of MACE. The risk of MACE was higher in men in the lowest quintile of the measures of bone strength versus four upper quintiles jointly (distal radius stiffness: HR = 2.46, 95% CI 1.27-4.74, p < .01). Similar results were obtained in 638 men without prior fragility fracture and in 689 men without ischemic heart disease at baseline. Thus, in older men followed prospectively for 8 years, higher aBMD, preserved cortical bone status, and higher estimated bone strength were associated with lower risk of MACE after adjustment for relevant confounders. © 2021 American Society for Bone and Mineral Research (ASBMR).
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