FRAX in conjunction with T-score predicts cardiovascular risk in older adults: a retrospective cohort bone density study from Thailand.

UNLABELLED: This retrospective cohort found that osteoporosis (defined by T-score) or FRAX score is linked to a higher risk of non-fatal stroke. Additionally, a high FRAX score combined with T-score increases the risk of both major adverse cardiovascular events (MACE) and non-fatal stroke.

PURPOSE: This study examined the relationship between osteoporosis and major adverse cardiovascular events (MACE) in Thai older adults and evaluated the predictive capacity of the FRAX score for cardiovascular risk.

METHODS

A retrospective cohort study followed 348 individuals aged 60-75 Years for over 13 years (2005-2021) after their initial bone mineral density (BMD) assessment. Osteoporosis was defined by BMD T-scores ≤ -2.5 at the lumbar spine or femoral neck, or fragility fracture. High hip fracture risk was defined as a FRAX score ≥ 3%. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke (3P-MACE). Cox proportional hazards models were used to calculate hazard ratios (HR). Statistical significance was set at p < 0.05.

RESULTS

While overall MACE was not significantly higher in the osteoporosis group, the stroke findings were increased (adjusted HR 2.46, 95% CI 1.12-5.39, p = 0.024). Utilizing FRAX score in conjunction with T-scores (FRAX-T ≥ 3%) was independently associated with an elevated risk of 3P-MACE (adjusted HR 1.88, 95% CI 1.05-3.38, p = 0.034) as well as non-fatal stroke risk (adjusted HR 3.04, 95% CI 1.38-6.69, p = 0.006).

CONCLUSIONS

Osteoporosis demonstrates a significant association with increased stroke risk in Thai older adults. Utilizing FRAX-T may improve cardiovascular risk stratification. Further large-scale prospective studies are needed to elucidate the underlying mechanisms and establish a definitive link between osteoporosis and broader cardiovascular outcomes in this population.