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Automated abdominal aortic calcification and trabecular bone score independently predict incident fracture during
Abadi K Gebre1, Marc Sim1,2, Syed Zulqarnain Gilani1,3,4
1Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia.
Insights
High abdominal aortic calcification (AAC) is linked to lower trabecular bone score (TBS) in older adults. Both AAC and TBS independently predict fracture risk, offering complementary insights for osteoporosis screening.
Area of Science:
- Gerontology
- Osteoporosis Research
- Cardiovascular Health
Background:
- Abdominal aortic calcification (AAC) is a marker of subclinical cardiovascular disease and has been linked to low bone mineral density (BMD) and fractures.
- The relationship between AAC and trabecular bone score (TBS), a measure of bone texture, and their independent predictive value for fracture risk remain unclear.
Purpose of the Study:
- To examine the cross-sectional association between AAC, assessed by a machine learning algorithm (ML-AAC24), and TBS.
- To determine the simultaneous association of ML-AAC24 and TBS with incident fractures in a large cohort.
Main Methods:
- Utilized data from the Manitoba BMD Registry, including 7,691 individuals (93.4% women, mean age 75.3 years).
- Employed generalized linear regression to test the association between ML-AAC24 and TBS.
- Applied Cox proportional hazards models to assess the simultaneous relationships of ML-AAC24 and TBS with incident fractures.
Main Results:
- High ML-AAC24 was associated with lower TBS (0.81% decrease) in multivariable-adjusted models.
- Both high ML-AAC24 and lower TBS were independently associated with increased risk of any incident fracture, major osteoporotic fracture, and hip fracture.
- High ML-AAC24 (HR 1.41) and lower TBS (HR 1.13 per SD decrease) significantly predicted fracture risk.
Conclusions:
- High ML-AAC24 is associated with lower TBS in older adults undergoing osteoporosis screening.
- Both ML-AAC24 and TBS provide complementary prognostic information for fracture risk assessment.
- These findings highlight the potential of combining cardiovascular and bone health assessments for improved fracture prediction.
Abstract:
Abdominal aortic calcification (AAC), a marker of subclinical cardiovascular disease, has previously shown to be associated with low BMD and fracture. However, it remains unclear whether AAC is associated with trabecular bone score (TBS), a gray-level textural measure, or whether it predicts fracture risk independent of this measure. Here, we examined the cross-sectional association of AAC scored using a validated machine learning algorithm (ML-AAC24) with TBS, and their simultaneous associations with incident fractures in 7691 individuals (93.4% women) through the Manitoba BMD Registry (mean age 75.3 yr). The association between ML-AAC24 and TBS was tested using generalized linear regression. Cox proportional hazards models tested the simultaneous relationships of ML-AAC24 and TBS with incident fractures. At baseline, 41.3% of the study cohort had low (<2), 32.4% had moderate (2 to <6), and 26.3% had high (≥6) ML-AAC24. Compared to low ML-AAC24, high ML-AAC24 was associated with a 0.81% lower TBS in the multivariable-adjusted model. Independent of each other and multiple established fracture risk factors, ML-AAC24 and TBS were each associated with an increased risk of incident fractures. Specifically, high ML-AAC24 (HR 1.41, 95% CI: 1.15-1.73, compared to low ML-AAC24) and lower TBS (HR 1.13, 95% CI: 1.05-1.22, per SD decrease) were associated with increased relative hazards for any incident fracture. High ML-AAC24 and lower TBS were also associated with incident major osteoporotic fracture (HR 1.48, 95% CI: 1.18-1.87 and HR 1.15, 95% CI: 1.06-1.25, respectively) and hip fracture (HR 1.56, 95% CI: 1.05-2.31 and HR 1.25, 95% CI: 1.08-1.44, respectively). In conclusion, high ML-AAC24 is associated with lower TBS in older adults attending routine osteoporosis screening. Both measures were associated with incident fractures. The findings of this study highlight high ML-AAC24, seen in more than 1 in 4 of the study cohort, and lower TBS provide complementary prognostic information for fracture risk.
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