The Association of Bone Mineral Density with Cardiovascular Disease

Cardiovascular disease (CVD) and osteoporosis are common age-related conditions with major public health impact. Mounting evidence suggests a link between the two diseases. The purpose of this research was to investigate the association of BMD measures (areal and volumetric) with prevalent CVD, incident CVD, and subclinical measures of atherosclerosis.We utilized data from two prospective epidemiological studies: a) the Health, Aging, and Body Composition (Health ABC) study that enrolled a population of older men and women (age 68-80 years, 51% women, 42% black), and b) the Study of Women's Health Across the Nation (SWAN) that followed a cohort of women through the menopause transition (age 45-58 years, 61% white, 64% peri-menopausal).In the cross-sectional Health ABC analysis, lower volumetric BMD (vBMD) measures of the spine were associated with higher CVD prevalence in men and women, and areal BMD (aBMD) of the trochanter was related to CVD in women. Additionally, aBMD of the total hip was related to subclinical peripheral arterial disease in men.In the SWAN analysis, we observed an inverse cross-sectional association between trabecular vBMD of the spine and aortic calcification. Meanwhile, no associations with coronary artery calcification were noted after adjusting for age.In the longitudinal Health ABC analysis, lower vBMD measures of the spine were associated with higher CVD incidence in white men, but not in blacks. In women, aBMD of the femoral neck was associated with incident CVD in the full cohort. In race-specific analyses, aBMD measures of the total hip, femoral neck, and trochanter exhibited significant relationships with incident CVD in black women, but not in whites.These relationships were independent of age and shared risk factors between osteoporosis and CVD. The inflammatory cytokines interleukin-6 and tumor necrosis factor-alpha, oxidized LDL, and endogenous estradiol did not explain these associations. Overall, our findings provide epidemiological evidence for the presence of an inverse association between BMD and CVD. An understanding of the common mechanisms underlying bone loss and atherogenesis has significant public health implications as it may set the stage for dual-purpose preventive and therapeutic interventions that target both osteoporosis and CVD