Abdominal Aortic Calcification May Indicate Higher Fracture Risk in Older Women

Abdominal aorta. Coloured 3D computed tomography (CT) angiogram of the abdominal aorta of a 53 year old patient. The aorta is the body’s main artery. It carries blood from the heart to the rest of the body. At centre left and right are the kidneys, with the renal arteries seen branching from the aorta. There is a small a fatty plaque (white, atherosclerosis) in the lower aorta.
Older women with significant abdominal aortic calcification are more likely to experience incident clinical fractures.

Older women with significant abdominal aortic calcification (AAC) are more likely to experience fractures than those with low AAC, according to study results published in the Journal of Bone and Mineral Research.

Researchers conducted this prospective 10-year study of 1024 women with AAC (mean age, 75 years) from a previous study to examine how vascular disease affects risk for osteoporosis as well as the association between AAC, skeletal structure, and fractures. Spine fracture and AAC severity (scored 0-24) were assessed at time of hip densitometry and heel quantitative ultrasound.

Of the included patients, 459 had low AAC (score 0-1), 373 had moderate AAC (score 2-5), and 192 had severe AAC (score ≥6). AAC score was inversely associated with hip bone mineral density (rs=-0.077; P =.013), heel broadband ultrasound attenuation (rs=-0.074; P =.020), and stiffness index (rs=-0.077; P =.022).

According to cross-sectional analyses, women with moderate to severe AAC were more likely to experience prevalent fracture and lumbar spine fractures, but not thoracic spine fractures (P <.05).

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Furthermore, compared with women who had low AAC, those with moderate to severe AAC were also at significantly greater risk for 10-year incident clinical fractures and fracture-related hospitalizations (hazard ratio [HR], 1.48; P =.002; and HR, 1.46; P =.019, respectively). After adjusting for age and hip bone mineral density, this relationship was still significant for clinical fractures (HR, 1.40; P =.010) but was reduced for fracture-related hospitalizations (HR, 1.33; P =.073).

Limitations included an inability to establish causation because of the study’s observational design.

In summarizing their findings, the researchers said, “women with both prevalent vertebral fractures and moderate to severe AAC had substantially higher incident fracture risk than either conditional alone. These findings suggest that concurrently capturing prevalent vertebral fractures and AAC may identify a small but previously underappreciated group of women at high risk of future fracture.”

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Lewis JR, Eggermont CJ, Schousboe JT, et al. Association between abdominal aortic calcification, bone mineral density and fracture in older women [published online July 16, 2019]. J Bone Miner Res. doi:10.1002/jbmr.3830