Association between trabecular bone score and cardiovascular outcomes: a population-level historical cohort study

This study found that a low lumbar spine trabecular bone score (TBS), measured during osteoporosis screening, predicts major cardiovascular events like heart attack and stroke. These results suggest TBS is a new risk factor for heart disease in people being evaluated for bone health.

Osteoporosis and cardiovascular disease have shared risk factors. Risk stratification for both diseases is suboptimal. Lumbar spine trabecular bone score (TBS), derived from tests used for measuring bone mineral density (BMD), is approved for fracture risk assessment and complements conventional risk factors. The objective of this study was to evaluate the ability of TBS to predict major adverse cardiovascular events (MACE).

Population-level cohort study of individuals aged ≥ 40 years referred to the Manitoba BMD Program for assessment by dual-energy X-ray absorptiometry (DXA) between February 28, 1999, and March 20, 2016. Lumbar spine TBS was measured on all DXAs and incident MACE, which included acute myocardial infarction (MI), non-hemorrhagic stroke, and all-cause mortality was ascertained from provincial administrative databases.

The study cohort included 66,572 individuals. Over a mean observation period of 9.5 years, 14,833 (22.3%) individuals experienced an incident MACE after the index date, including 2789 (4.2%) who experienced an acute myocardial infarction, 2434 (3.7%) who experienced a stroke, and 12,410 (18.6%) who died. The fully adjusted HR for MACE with each SD decrease in TBS was 1.13 (95% CI 1.17-1.30). MACE was also associated with lower TBS, even when excluding those with previous cardiovascular disease, with an adjusted HR per SD decrease of 1.19 (95% CI 1.16-1.22). Significant effects were also seen for the individual MACE endpoints.

TBS is a novel cardiovascular risk factor in individuals undergoing osteoporosis assessment.