Women who have thin and brittle bones face an increased risk of developing heart disease, researchers have reported.
A study team from Seoul National University Bundang Hospital, Seoul National University College of Medicine and Yonsei University College of Medicine, South Korea, found that thinning of the lumbar spine, femoral neck and hip were particularly predictive of a heightened risk of heart attack and stroke.
It is believed people with osteoporosis often have atherosclerosis, but while the risk of a cardiovascular death is 21% in women, compared to 15% in men, the predictive risk framework for heart disease is skewed towards men.
The team said it was important to better identify women at higher risk of a heart attack or stroke.
For this observational study, which is published in the latest edition of Heart, they reviewed the medical records of women aged 50 to 80 who’d had a DXA scan at Seoul National University Bundang Hospital between 2005 and 2014 to check for osteoporosis.
The final analysis comprised 12,681 women whose health was tracked for an average of nine years, using national registry data.
During the monitoring period, 468 women (about 4%) had a heart attack or stroke and 237 (2%) died.
The team found that a low bone mineral density score at the lumbar spine, femoral neck, and hip were independently associated 16% to 38% risk of heart attack or stroke after taking account of potentially influential factors.
A formal diagnosis of osteoporosis was also independently associated with a 79% higher risk of cardiovascular disease.
They write that adding bone mineral density score or a clinical diagnosis of osteoporosis or osteopenia to clinical risk factors more effectively predicted risk than clinical risk factors alone.
Although it is unclear how osteoporosis and atherosclerosis are linked, the team says long-term inflammation and cumulative oxidative stress play major roles in age-related bone loss and atherosclerosis, while sex hormones, particularly oestrogen, help regulate bone turnover and the vascular system.
Although this is an observational study, the authors say: “Considering that [DXA scanning] is widely used to screen for osteopenia and osteoporosis in asymptomatic women, the significant association between [bone mineral density] and higher risk of [cardiovascular disease] provides an opportunity for large-scale risk assessment in women without additional cost and radiation exposure.”
Park J, Yoon YE, Kim KM et al. Prognostic value of lower bone mineral density in predicting adverse cardiovascular disease in Asian women. Heart 7 May 2021; doi 10.1136/heartjnl-2020-318764
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