Top

Osteoporosis International

Published in:

01-04-2013 | Original Article

Severity of aortic calcification is positively associated with vertebral fracture in older men—a densitometry study in the STRAMBO cohort

Authors: P. Szulc, E. J. Samelson, E. Sornay-Rendu, R. Chapurlat, D. P. Kiel

Published in: Osteoporosis International | Issue 4/2013

Abstract

Summary

In older men, severe abdominal aortic calcification and vertebral fracture (both assessed using dual-energy X-ray absorptiometry) were positively associated after adjustment for confounders including bone mineral density.

Introduction

Abdominal aortic calcification (AAC) is associated with higher fracture risk, independently of low bone mineral density (BMD). Dual-energy X-ray absorptiometry (DXA) can be used to assess both vertebral fracture and AAC and requires less time, cost, and radiation exposure.

Methods

We conducted a cross-sectional study of the association between AAC and prevalent vertebral fractures in 901 men ≥50 years old. We used DXA (vertebral fracture assessment) to evaluate BMD, vertebral fracture, and AAC.

Results

Prevalence of vertebral fracture was 11 %. Median AAC score was 1 and 12 % of men had AAC score >6. After adjustment for age, weight, femoral neck BMD, smoking, ischemic heart disease, diabetes, and hypertension, AAC score >6 (vs ≤6) was associated with 2.5 (95 % CI, 1.4–4.5) higher odds of vertebral fracture. Odds of vertebral fracture for AAC score >6 increased with vertebral fracture severity (grade 1, OR = 1.8; grade 2, OR = 2.4; grade 3, OR = 4.4; trend p < 0.01) and with the number of vertebral fractures (1 fracture, OR = 2.0, >1 fracture, OR = 3.5). Prevalence of vertebral fracture was twice as high in men having both a T-score < −2.0 and an AAC score > 6 compared with men having only one of these characteristics.

Conclusions

Men with greater severity AAC had greater severity and greater number of vertebral fractures, independently of BMD and co-morbidities. DXA can be used to assess vertebral fracture and AAC. It can provide a rapid, safe, and less expensive alternative to radiography. DXA may be an important clinical tool to identify men at high risk of adverse outcomes from osteoporosis and cardiovascular disease.

Bagger YZ, Tankó LB, Alexandersen P, Qin G, Christiansen C (2006) Radiographic measure of aorta calcification is a site-specific predictor of bone loss and fracture risk at the hip. J Intern Med 259:598–605PubMedCrossRef

Wang TK, Bolland MJ, Pelt NC, Horne AM, Mason BH, Ames RW, Grey AB, Ruygrok PN, Gamble GD, Reid IR (2010) Relationships between vascular calcification, calcium metabolism, bone density, and fractures. J Bone Miner Res 25:2501–2509

Naves M, Rodríguez-García M, Díaz-López JB, Gómez-Alonso C, Cannata-Andía JB (2008) Progression of vascular calcifications is associated with greater bone loss and increased bone fractures. Osteoporos Int 19:1161–1166PubMedCrossRef

Rajzbaum G, Roger VL, Bézie Y, Chauffert M, Bréville P, Roux F, Safar ME, Blacher J (2005) French women, fractures and aortic calcifications. J Intern Med 257:117–119PubMedCrossRef

Szulc P, Kiel DP, Delmas PD (2008) Calcifications in the abdominal aorta predict fractures in men: MINOS study. J Bone Miner Res 23:95–102PubMedCrossRef

Schulz E, Arfai K, Liu X, Sayre J, Gilsanz V (2004) Aortic calcification and the risk of osteoporosis and fractures. J Clin Endocrinol Metab 89:4246–4253PubMedCrossRef

Farhat GN, Cauley JA, Matthews KA, Newman AB, Johnston J, Mackey R, Edmundowicz D, Sutton-Tyrrell K (2006) Volumetric BMD and vascular calcification in middle-aged women: the Study of Women's Health Across the Nation. J Bone Miner Res 21:1839–1846PubMedCrossRef

Hyder JA, Allison MA, Wong N, Papa A, Lang TF, Sirlin C, Gapstur SM, Ouyang P, Carr JJ, Criqui MH (2009) Association of coronary artery and aortic calcium with lumbar bone density: the MESA Abdominal Aortic Calcium Study. Am J Epidemiol 169:186–194PubMedCrossRef

Jamal SA, Leiter RE, Bauer DC (2005) Hyperhomocysteinaemia and aortic calcification are associated with fractures in patients on haemodialysis. QJM 98:575–579PubMedCrossRef

10.

Iwamoto J, Matsumoto H, Takeda T, Sato Y, Uzawa M (2010) A radiographic study on the associations of age and prevalence of vertebral fractures with abdominal aortic calcification in Japanese postmenopausal women and men. J Osteoporos 2010:748380PubMed

11.

Hofbauer LC, Brueck CC, Shanahan CM, Schoppet M, Dobnig H (2007) Vascular calcification and osteoporosis—from clinical observation towards molecular understanding. Osteoporos Int 18:251–259PubMedCrossRef

12.

Wilson PW, Kauppila LI, O'Donnell CJ, Kiel DP, Hannan M, Polak JM, Cupples LA (2001) Abdominal aortic calcific deposits are an important predictor of vascular morbidity and mortality. Circulation 103:1529–1534PubMedCrossRef

13.

Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521PubMedCrossRef

14.

Rea JA, Li J, Blake GM, Steiger P, Genant HK, Fogelman I (2000) Visual assessment of vertebral deformity by X-ray absorptiometry: a highly predictive method to exclude vertebral deformity. Osteoporos Int 11:660–668PubMedCrossRef

15.

Schousboe JT, Debold CR (2006) Reliability and accuracy of vertebral fracture assessment with densitometry compared to radiography in clinical practice. Osteoporos Int 17:281–289PubMedCrossRef

16.

Schousboe JT, Wilson KE, Hangartner TN (2007) Detection of aortic calcification during vertebral fracture assessment (VFA) compared to digital radiography. PLoS One 8:e715CrossRef

17.

Schousboe JT, Taylor BC, Kiel DP, Ensrud KE, Wilson KE, McCloskey EV (2008) Abdominal aortic calcification detected on lateral spine images from a bone densitometer predicts incident myocardial infarction or stroke in older women. J Bone Miner Res 23:409–416PubMedCrossRef

18.

McCloskey EV, Vasireddy S, Threlkeld J, Eastaugh J, Parry A, Bonnet N, Beneton M, Kanis JA, Charlesworth D (2008) Vertebral fracture assessment (VFA) with a densitometer predicts future fractures in elderly women unselected for osteoporosis. J Bone Miner Res 23:1561–1568PubMedCrossRef

19.

Chaitou A, Boutroy S, Vilayphiou N, Munoz F, Delmas PD, Chapurlat R, Szulc P (2010) Association between bone turnover rate and bone microarchitecture in men—the STRAMBO study. J Bone Miner Res 25:2313–2323PubMedCrossRef

20.

Kauppila LI, Polak JF, Cupples LA, Hannan MT, Kiel DP, Wilson PW (1997) New indices to classify location, severity and progression of calcific lesions in the abdominal aorta: a 25-year follow-up study. Atherosclerosis 132:245–250PubMedCrossRef

21.

Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148PubMedCrossRef

22.

Szulc P, Munoz F, Marchand F, Delmas PD (2001) Semiquantitative evaluation of prevalent vertebral deformities in men and their relationship with osteoporosis: the MINOS study. Osteoporos Int 12:302–310PubMedCrossRef

23.

Szulc P, Boutroy S, Vilayphiou N, Chaitou A, Delmas PD, Chapurlat R (2011) Cross-sectional analysis of the association between fragility fractures and bone microarchitecture in older men: the STRAMBO study. J Bone Miner Res 26:1358–1367PubMedCrossRef

24.

Samelson EJ, Cupples LA, Broe KE, Hannan MT, O'Donnell CJ, Kiel DP (2007) Vascular calcification in middle age and long-term risk of hip fracture: the Framingham Study. J Bone Miner Res 22:1449–1454PubMedCrossRef

25.

Flipon E, Liabeuf S, Fardellone P, Mentaverri R, Ryckelynck T, Grados F, Kamel S, Massy ZA, Dargent-Molina P, Brazier M (2012) Is vascular calcification associated with bone mineral density and osteoporotic fractures in ambulatory, elderly women? Osteoporos Int 23:1533–1539PubMedCrossRef

26.

Frye MA, Melton LJ 3rd, Bryant SC, Fitzpatrick LA, Wahner HW, Schwartz RS, Riggs BL (1992) Osteoporosis and calcification of the aorta. Bone Miner 19:185–194PubMedCrossRef

27.

Rodríguez-García M, Gómez-Alonso C, Naves-Díaz M, Diaz-Lopez JB, Diaz-Corte C, Cannata-Andía JB (2009) Vascular calcifications, vertebral fractures and mortality in haemodialysis patients. Nephrol Dial Transplant 24:239–246PubMedCrossRef

28.

Kim SH, Kim YM, Cho MA, Rhee Y, Hur KY, Kang ES, Cha BS, Lee EJ, Lee HC, Lim SK (2008) Echogenic carotid artery plaques are associated with vertebral fractures in postmenopausal women with low bone mass. Calcif Tissue Int 82:411–417PubMedCrossRef

29.

Collins TC, Ewing SK, Diem SJ, Taylor BC, Orwoll ES, Cummings SR, Strotmeyer ES, Ensrud KE (2009) Peripheral arterial disease is associated with higher rates of hip bone loss and increased fracture risk in older men. Circulation 119:2305–2312PubMedCrossRef

30.

Tankó LB, Christiansen C, Cox DA, Geiger MJ, McNabb MA, Cummings SR (2005) Relationship between osteoporosis and cardiovascular disease in postmenopausal women. J Bone Miner Res 20:1912–1920PubMedCrossRef

31.

Vestergaard P, Rejnmark L, Mosekilde L (2009) Hypertension is a risk factor for fractures. Calcif Tissue Int 84:103–111PubMedCrossRef

32.

Sennerby U, Farahmand B, Ahlbom A, Ljunghall S, Michaëlsson K (2007) Cardiovascular diseases and future risk of hip fracture in women. Osteoporos Int 18:1355–1362PubMedCrossRef

33.

Lawlor DA, Patel R, Ebrahim S (2003) Association between falls in elderly women and chronic diseases and drug use: cross sectional study. BMJ 327:712–717PubMedCrossRef

34.

Gribbin J, Hubbard R, Gladman JR, Smith C, Lewis S (2010) Risk of falls associated with antihypertensive medication: population-based case–control study. Age Ageing 39:592–597PubMedCrossRef

35.

Chow JT, Khosla S, Melton LJ 3rd, Atkinson EJ, Camp JJ, Kearns AE (2008) Abdominal aortic calcification, BMD, and bone microstructure: a population-based study. J Bone Miner Res 23:1601–1612PubMedCrossRef

36.

Szulc P, Varennes A, Delmas PD, Goudable J, Chapurlat R (2010) Men with metabolic syndrome have lower bone mineral density but lower fracture risk–the MINOS study. J Bone Miner Res 25:1446–1454PubMedCrossRef

37.

Yamaguchi T, Kanazawa I, Yamamoto M, Kurioka S, Yamauchi M, Yano S, Sugimoto T (2009) Associations between components of the metabolic syndrome versus bone mineral density and vertebral fractures in patients with type 2 diabetes. Bone 45:174–179PubMedCrossRef

38.

Talbott EO, Zborowski JV, Rager JR, Boudreaux MY, Edmundowicz DA, Guzick DS (2004) Evidence for an association between metabolic cardiovascular syndrome and coronary and aortic calcification among women with polycystic ovary syndrome. J Clin Endocrinol Metab 89:5454–5461PubMedCrossRef

39.

Van Campenhout A, Moran CS, Parr A, Clancy P, Rush C, Jakubowski H, Golledge J (2009) Role of homocysteine in aortic calcification and osteogenic cell differentiation. Atherosclerosis 202:557–566PubMedCrossRef

40.

Shiraki M, Kuroda T, Shiraki Y, Tanaka S, Higuchi T, Saito M (2011) Urinary pentosidine and plasma homocysteine levels at baseline predict future fractures in osteoporosis patients under bisphosphonate treatment. J Bone Miner Metab 29:62–70PubMedCrossRef

41.

Hoshino H, Takahashi M, Kushida K, Ohishi T, Kawana K, Inoue T (1995) Quantitation of the crosslinks, pyridinoline, deoxypyridinoline and pentosidine, in human aorta with dystrophic calcification. Atherosclerosis 112:39–46PubMedCrossRef

42.

Follet H, Viguet-Carrin S, Burt-Pichat B, Dépalle B, Bala Y, Gineyts E, Munoz F, Arlot M, Boivin G, Chapurlat RD, Delmas PD, Bouxsein ML (2011) Effects of preexisting microdamage, collagen cross-links, degree of mineralization, age, and architecture on compressive mechanical properties of elderly human vertebral trabecular bone. J Orthop Res 29:481–488PubMedCrossRef

43.

Garnero P, Borel O, Gineyts E, Duboeuf F, Solberg H, Bouxsein ML, Christiansen C, Delmas PD (2006) Extracellular post-translational modifications of collagen are major determinants of biomechanical properties of fetal bovine cortical bone. Bone 38:300–309PubMedCrossRef

44.

Viguet-Carrin S, Roux JP, Arlot ME, Merabet Z, Leeming DJ, Byrjalsen I, Delmas PD, Bouxsein ML (2006) Contribution of the advanced glycation end product pentosidine and of maturation of type I collagen to compressive biomechanical properties of human lumbar vertebrae. Bone 39:1073–1079PubMedCrossRef

45.

Tanaka S, Narusawa K, Onishi H, Miura M, Hijioka A, Kanazawa Y, Nishida S, Ikeda S, Nakamura T (2011) Lower osteocalcin and osteopontin contents of the femoral head in hip fracture patients than osteoarthritis patients. Osteoporos Int 22:587–597PubMedCrossRef

46.

Shao JS, Sierra OL, Cohen R, Mecham RP, Kovacs A, Wang J, Distelhorst K, Behrmann A, Halstead LR, Towler DA (2011) Vascular calcification and aortic fibrosis: a bifunctional role for osteopontin in diabetic arteriosclerosis. Arterioscler Thromb Vasc Biol 31:1821–1833PubMedCrossRef

Title: Severity of aortic calcification is positively associated with vertebral fracture in older men—a densitometry study in the STRAMBO cohort
Authors: P. Szulc
E. J. Samelson
E. Sornay-Rendu
R. Chapurlat
D. P. Kiel
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 4/2013
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-012-2101-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Severity of aortic calcification is positively associated with vertebral fracture in older men—a densitometry study in the STRAMBO cohort

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2013

Quantitative vertebral morphometry based on parametric modeling of vertebral bodies in 3D

Changes in calcitropic hormones, bone markers and insulin-like growth factor I (IGF-I) during pregnancy and postpartum: a controlled cohort study

Increased risk of osteoporosis-related fractures in patients with irritable bowel syndrome

Risk factors affecting progressive collapse of acute osteoporotic spinal fractures

The assessment of vertebral fractures in elderly women with recent hip fractures: the BREAK Study

Hip fracture and other predictors of anti-osteoporosis drug use in Norway