Abdominal aortic calcification, bone mineral density and fracture in elderly women — ASN Events
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Abdominal aortic calcification, bone mineral density and fracture in elderly women (#89)

Joshua R Lewis 1 2 , Celeste Eggermont 3 , John T Schousboe 4 , Wai H Lim 3 5 , Germaine Wong 1 , MingXiang Yu 3 6 , Kun Zhu 3 7 , Kevin Wilson 8 , Douglas P Kiel 9 , Richard Prince 3 7
  1. Centre for Kidney Research, School of Public Health, School of Medicine, University of Sydney, Sydney, NSW, Australia
  2. University of Sydney, Westmead, NSW, Australia
  3. School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
  4. Division of Health Policy and Management, University of Minnesota, Minneapolis, USA
  5. Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
  6. Department of endocrinology & metabolism , Shanghai Zhongshan Hospital, Fudan University, Shanghai, China
  7. Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
  8. Skeletal Health, Hologic Inc, Bedford, MA, USA
  9. Institute for Aging Research, Hebrew Senior Life, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

Lateral spine imaging from bone densitometry is performed for vertebral fracture assessment, but can also be used to evaluate abdominal aortic calcification (AAC). Recent evidence from studies using standard radiographs suggest AAC is a fracture risk factor. To date no studies have investigated AAC on lateral spine images from bone densitometers. We therefore undertook a prospective study of 1,024 elderly women with bone densitometry and lateral spine images in 1998 or 1999. Over 10 years of follow up, self-reported fractures were adjudicated by review of clinical radiograph reports (n=253) and hospitalised fractures were identified from the Western Australian Hospital Morbidity Data system (n=169). AAC was scored using the Kauppila 24-point scale from the lateral spine images. The FRAX (Australia) 10-year probabilities of a major osteoporotic fracture with or without femoral neck BMD were used to estimate fracture risk. The participants mean age was 75.0 ± 2.6 SD years. Significant inverse Spearman’s rank correlations were observed between AAC24 scores and hip BMC (rs=-0.084, P=0.007) and BMD (rs=-0.077, P=0.013) as well as the heel quantitative ultrasound measures, broadband ultrasound attenuation and stiffness index (rs=-0.074, P=0.020 and rs=-0.073, P=0.022 respectively). Compared to women with low AAC (AAC24 score 0 or 1), women with moderate to severe AAC (AAC24 score > 1) had an increased risk for 10-year self-reported fracture and fracture-related hospitalisations before (HR 1.48 [1.15-1.91], P=0.002 and HR 1.46 [1.07-1.99], P=0.019 respectively), and after adjustment for FRAX without BMD 10-year estimated fracture risk (HR 1.45 [1.12-1.87], P=0.005 and HR 1.39 [1.01-1.90], P=0.048 respectively). Only self-reported fractures remained significant after adjustment for FRAX with BMD 10-year estimated fracture risk (HR 1.40 (1.08-1.81), P=0.011). These findings support the hypothesis that vascular calcification is related to hip bone mineral content and density and is a risk factor for fractures in elderly women. The mechanisms underlying these associations remain to be identified.