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Association between bone health and cardiovascular events in a population-based cohort
Álex García Tellado1, Mercedes de la Fuente1, José Luis Hernández1
1Department of Internal Medicine , Marqués de Valdecilla University Hospital, University of Cantabria, Valdecilla Health Research Institute (IDIVAL), 3D-Shaper Medical, Barcelona, Spain.
Insights
Osteoporotic fractures and lower trabecular bone density predict cardiovascular events, independent of traditional risk factors. This suggests bone health is linked to cardiovascular health, highlighting a potential new area for risk assessment and prevention strategies.
Area of Science:
- Cardiology
- Osteoporosis Research
- Public Health
Background:
- Low bone mineral density (BMD) is potentially linked to cardiovascular disease (CVD) risk, but the causal relationship remains unclear.
- Assessing the association between bone health and cardiovascular events is crucial for understanding disease mechanisms and improving patient outcomes.
Purpose of the Study:
- To investigate the association between bone mineral density (BMD), osteoporotic fractures, and the risk of subsequent cardiovascular events in a general population sample.
- To determine if bone health metrics independently predict cardiovascular events in both men and women, adjusting for established risk factors.
Main Methods:
- A prospective observational cohort study of 1233 individuals (76% women, mean age 62.5 years) from the Camargo cohort in Northern Spain.
- Baseline assessments included DXA-based BMD, trabecular bone score (TBS), and volumetric BMD (vBMD) by 3D-DXA. Incident cardiovascular events were monitored over a mean follow-up of 14.3 years.
- Cox regression analyses were employed to assess the association between bone health parameters, osteoporotic fractures, and cardiovascular event risk, controlling for traditional cardiovascular risk factors.
Main Results:
- During follow-up, 240 participants (19.5%) experienced cardiovascular events. Individuals with events were older and had more comorbidities.
- A history of osteoporotic fracture independently increased cardiovascular risk by 125% (HR 2.25). Lower trabecular vBMD and TBS were associated with higher event rates.
- While areal BMD did not predict events, each 1 SD increase in trabecular vBMD was associated with a 14% reduction in cardiovascular risk (HR 0.86).
Conclusions:
- Prior osteoporotic fractures and reduced trabecular volumetric bone density (vBMD) are significant independent predictors of cardiovascular event risk.
- These findings suggest that bone health assessment, particularly trabecular bone characteristics, may offer valuable insights into an individual's cardiovascular risk profile.
- Bone health could play a more direct role in the development of cardiovascular events than previously understood, warranting further investigation.
Abstract:
Brief rationale: Low bone mineral density may be linked to cardiovascular risk, but causality is unclear.
Main Result:
In 1233 individuals followed for 14 years, osteoporotic fractures and trabecular vBMD independently predicted cardiovascular events, while areal BMD did not. Significance of the paper: Bone health could be associated with the development of cardiovascular events.
Purpose:
In this observational cohort of a general population sample, we aimed to assess the association between bone mineral density (BMD) and osteoporotic fractures on the risk of subsequent cardiovascular events in both sexes.
Methods:
This prospective study included 1233 individuals (mean age 62.5 ± 8.4 years; 76% women) from the Camargo cohort in Northern Spain, followed for 14.3 ± 4.0 years. Baseline clinical data, DXA-based BMD (lumbar spine, femoral neck, total hip), trabecular bone score (TBS), and volumetric BMD by 3D-DXA were analyzed. Incident cardiovascular events (myocardial infarction, stroke, peripheral artery disease) were documented. Cox regression analyses were performed adjusting for cardiovascular risk factors.
Results:
During follow-up, 240 participants (19.5%) experienced cardiovascular events. These individuals were older and had higher rates of hypertension, diabetes, dyslipidemia, smoking, atrial fibrillation, and previous cardiovascular event. A history of osteoporotic fracture was more frequent among those with cardiovascular events (9.6% vs. 3.1%, HR 2.59). Lower trabecular vBMD and TBS were observed in the event group, while areal BMD showed no significant differences. Adjusted analyses revealed that a history of osteoporotic fracture independently increased cardiovascular risk by 125% (HR 2.25; 95% CI 1.43-3.54). Moreover, for each 1 SD increase in trabecular vBMD, the risk was slightly reduced by 14% (HR 0.86; 95% CI 0.74-0.99).
Conclusions:
Our findings indicate that prior osteoporotic fractures and trabecular vBMD are significant predictors of cardiovascular event risk, independent of traditional risk factors.
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