Association of Lipoprotein(a) with Coronary Artery Calcification and Bone Mineral Density in Elderly Individuals

Coronary artery calcification (CAC) and osteoporosis are common age-related conditions that may share underlying mechanisms such as inflammation and lipid dysregulation. Lipoprotein(a) [Lp(a)] has been suggested as a potential contributor to both processes. This study aims to investigate the relationship between CAC, bone mineral density (BMD), and Lp(a) levels in a statin-naive elderly population.

This retrospective study included 310 patients aged ≥ 55 years who underwent coronary computed tomography angiography and Lp(a) measurement. CAC was assessed visually, and BMD was measured using vertebral Hounsfield units. Patients were stratified into three groups according to Lp(a) levels: ≤ 30, 30-49, and ≥ 50 mg/dL. Propensity score matching was performed for age and sex.

Patients with CAC had higher Lp(a) levels [36.4 +- 33.2 vs. 21.7 +- 27.8 mg/dL, P < 0.001], lower high-density lipoprotein cholesterol (HDL-C) [52.6 +- 14.6 vs. 57.5 +- 17.9 mg/dL, P = 0.010], and lower BMD [152.9 +- 50.2 vs. 169.1 +- 51.0 HU, P = 0.009]. In multivariate analysis, both Lp(a) and HDL-C were independent predictors of CAC. Low BMD and CAC prevalence increased stepwise across Lp(a) strata: in patients with Lp(a) ≤ 30 mg/dL, low BMD was present in 28.9% and CAC in 52.6%; in those with Lp(a) 30-49 mg/dL, 37.2% and 66.7%; and in those with Lp(a) ≥ 50 mg/dL, 58.6% and 80.3%, respectively (P = 0.002 and P = 0.001).

Elevated Lp(a) is associated with both CAC and low BMD. Lp(a) ≥ 50 mg/dL may serve as a shared biomarker to identify individuals at risk for concurrent vascular and skeletal deterioration.