Higher BMD, bone strength lower risk for major adverse coronary events in older men
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Older men with higher bone mineral density and preserved cortical bone are less likely to experience a major adverse coronary event, according to a study published in the Journal of Bone and Mineral Research.
“In older men, low areal BMD, low cortical bone mass, poor cortical bone microarchitecture and low estimated bone strength are associated with higher risk of major adverse coronary events, after adjustment for confounders,” Pawel Szulc, MD, PhD, from the unit of pathophysiology, diagnosis and treatments of bone diseases at the French Institute of Health and Medical Research, Lyon University, France, and colleagues wrote. “Our data on areal BMD confirm the previous studies showing that low areal BMD is associated with higher cardiovascular risk (including major adverse coronary events) and mortality.”
Researchers conducted a single-center prospective study with a cohort of men aged at least 60 years from the Lyon, France, region. All respondents who provided consent, answered questionnaires and participated in the medical exams were included. Participants had areal BMD measured at the lumbar spine, hip, whole body and distal radius. Microarchitecture was assessed at the nondominant distal radius and right distal tibia at baseline. Participants also responded to an epidemiologic questionnaire at baseline. An annual questionnaire was sent to participants each year to ask about major adverse coronary events.
Of 813 participants who were followed up prospectively, 53 had a major adverse coronary event. The risk for an event was lower for men with a higher areal BMD at all regions of interest in the study. Major adverse coronary events occurred more in those in the lowest BMD quartile compared with men in the highest quartile.
There were 47 major adverse coronary events reported in 745 participants with a valid distal radius scan. Men in the lowest quintiles for cortical density and cortical thickness had a higher risk for an adverse coronary event compared with those in the highest quintile. Among 779 men with a valid distal tibia scan, 48 had a major adverse coronary event. Participants with a higher cortical density, stiffness and failure load had a lower risk for a major adverse coronary event. The risk for an adverse coronary event was higher in the lowest quintile for cortical thickness, cortical density, trabecular number, stiffness and failure load than all other quintiles combined.
Of 638 participants without a prior fracture at baseline, 37 had an incident major adverse coronary event. Those with a higher areal BMD had a lower risk for a major adverse coronary event. In the hip, lumbar spine and whole body, the adjusted risk decreased across all quintiles, with those in the lowest BMD quintiles having the highest risk for a major adverse coronary event and men in the highest quintiles having the lowest risk.
Of 689 men without ischemic heart disease at baseline, 32 had a major adverse coronary event. The risk for an adverse coronary event decreased as areal BMD increased in the total hip, trochanter, whole body, and mid-distal and ultra-distal radius. There was no association between areal BMD and the risk for major adverse coronary events in the lumbar spine, femoral neck and one-third distal radius in those without heart disease.
“Our results indicate that poor cortical bone status is more strongly associated with the risk of major adverse coronary events than trabecular bone,” the researchers wrote. “However, they were obtained in an average-size cohort with a limited number of events and warrant further larger studies to better assess the link between bone status and the risk of major adverse coronary events in men.”
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