Association between bone health and cardiovascular events in a population-based cohort.

UNLABELLED: 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.