Low Bone Strength and Mass Associated With Increased Risk for Major Adverse Coronary Events in Older Men

Men with poor cortical bone status and lower estimated bone strength have a higher risk for major adverse coronary events, shows research published in the Journal of Bone and Mineral Research.

While many studies have established a link between bone fragility and cardiovascular diseases, most of these studies were conducted in women. In this study, which was published in February, researchers focus on the connection between bone fragility and major adverse coronary events in older men. Led by Pawel Szulc, MD, PhD, of Hôpital Edouard Herriot, France, researchers evaluated the relationship between baseline bone status and the risk for incident major adverse coronary events in men between 60 and 87 years old.

The data was based on a cohort of 825 men who participated in the Structure of the Aging Men’s Bones (STRAMBO) study, which was a single-center, prospective, community-based cohort study.  

Investigators measured areal bone mineral density at the lumbar spine, hip, distal radius, and whole body. Microarchitecture, which is a determinant of bone fragility independent of bone density, was evaluated in the nondominant distal radios and the right distal tibia using the Xtreme-CT-I device (Scanco Medical). Cardiovascular conditions were recorded based on the results of questionnaires completed by the study participants.

At follow-up nearly four years later, 53 of 760 men experienced at least one major adverse coronary event, but this applied mostly to the oldest tertiary who had lower appendicular lean mass, higher fat fraction, high-sensitivity C-reactive protein, and osteoprotegerin levels.

The most common heart condition was ischemic heart disease in which the men were most often treated with ACE inhibitors or calcium channel blockers. High blood pressure and abdominal aortic calcifications were also reported.

Results of multivariable models showed that severe abdominal aortic calcification (>6) was associated with a twofold higher risk for major adverse coronary events. Men with incident major adverse coronary events had lower areal bone mineral density at the lumbar spine, hip, and distal radius.

The risk for major adverse coronary events risk decreased with areal bone mineral density at all ROIs (hazard ratio [HR], 0.53-0.68 per SD), and major adverse coronary events incidence tended to be the highest in the lowest areal BMD quintile, and lowest in the highest quintile. Multivariable adjusted major adverse coronary events risk was lower in the highest vs the lowest quintile (HR, 0.06-0.32).

Of the 779 men with a valid distal tibia scan, 48 had incident major adverse coronary events; associations between HR-pQCT indices and major adverse coronary events were weaker. Multivariable models showed the higher Ct.BMD, stiffness, and failure to load were associated with lower major adverse coronary events risk (odds ratio [OR], 0.66-0.70 per SD).

Of the 638 men without fracture at baseline, 37 had incident major adverse coronary events. Major adverse coronary events incidence decreased across areal bone mineral density quintiles, and higher areal bone mineral density was associated with a lower risk (adjusted HR, 0.40 to 0.67 per SD). Adjusted major adverse coronary events risk decreased across areal BMD quintiles for hip ROIs, lumbar spine, and whole body.

Of the 689 men without ischemic heart disease, 32 had incident major adverse coronary events, and major adverse coronary events incidence decreased across areal bone mineral density quintiles. After adjusting for confounders, major adverse coronary events risk decreased with increasing areal bone mineral density at total hip, trochanter and whole body, mid-distal, and ultradistal radius areal BMD (HR, 0.52-0.64 per SD).

The risk for major adverse coronary events decreased with dual X-ray absorptiometry indices at all ROIs (HR, 0.46-0.65 per SD), and was lower in the highest as compared to the lowest quintile (HR, 0.06-0.29) with the exception of one-third distal radius.

The study had several limitations including the possibility that this study group may have been healthier than the norm for their age. And, men with severe diseases were more likely to drop out of the study.

“Our results indicate that poor cortical bone status is more strongly associated with the risk of major cardiovascular events than trabecular bone. 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 cardiovascular events in men,” the authors wrote. “If our hypothesis generating results are confirmed, they will warrant further studies on underlying mechanisms and markers of bone and cardiovascular

risk. For a clinician, they will strengthen the view that men with poor bone status need a careful assessment of their cardiovascular status.”

Disclosures:  This study was, in part, supported by a grant from Roche.

Reference

Szulc P, Foesser D, Chapurlat R. High cardiovascular risk in older men with poor bone microarchitecture—the prospective STRAMBO Study. Published online February 2, 2021. J Bone Miner Res. doi: 10.1002/jbmr.4261