BMD Measurement Can Help Improve Prediction of Cardiovascular Disease in Women

By David Douglas

May 13, 2021

NEW YORK (Reuters Health) - Evaluation of bone-mineral density (BMD) can improve risk stratification and guide clinical management of atherosclerotic cardiovascular disease (ASCVD) in women, suggests a large retrospective study from South Korea.

"We designed this study since the performance of the conventional prediction algorithms such as the pooled cohort equation (PCE) is limited in women," said Dr. Yeonyee Elizabeth Yoon of Yonsei University College of Medicine, in Yongin.

"New strategies that go beyond the measurement of conventional risk factors are needed to better identify women at higher risk for ASCVD," she told Reuters Health by email.

Dr. Yoon and colleagues analyzed data on more than 12,600 women aged 50 to 80 years who had undergone dual-energy X-ray absorptiometry (DXA) for osteoporosis screening between 2005 and 2014.

After a median follow-up of 9.2 years, a total of 468 women (3.7%) experienced ASCVD events. Lower BMD was independently associated with a significantly higher risk for such events, with adjusted hazard ratios per one standard-deviation decrease in BMD of 1.16 at the lumbar spine, 1.29 at the femur neck and 1.38 at the hip (all P<0.001).

A clinical diagnosis of osteoporosis was also independently associated with a higher risk for ASCVD events (aHR, 1.79), the team reports in Heart.

During follow-up, 237 women (1.9%) died of ASCVD. Lower BMD or the diagnosis of osteoporosis was associated with significantly higher risk of ASCVD deaths.

"Although risk prediction could be improved by additional tests, such as the coronary-artery calcium (CAC) score, widespread implementation of the CAC scan has been unsuccessful because of the perceived risks of radiation exposure and cost," Dr. Yoon said.

"In contrast," she continued, "DXA is widely used to screen for osteopenia and osteoporosis in asymptomatic women. Therefore, the present study results of an improved ASCVD risk prediction by assessing BMD suggest an opportunity to screen women for ASCVD in a manner that is effective, efficient, and broad-reaching. Moreover, in this study, we found that the risk for ASCVD could even be further stratified according to BMD in a subgroup of relatively young women with no risk factors."

"This result," Dr. Yoon concluded, "supports a potential role of BMD in identifying apparently healthy women potentially at increased ASCVD risk. Of course, before the widespread utilization of BMD to facilitate personalized decision-making, randomized controlled trials of an integrated screening and targeted prevention strategy are required."

Dr. Dexter Canoy of the University of Oxford, U.K., one of the authors of an accompanying editorial, told Reuters Health by email,s "This study is important primarily because the investigators found a relatively safe and low-cost measure that can predict very well the onset of heart disease and stroke in women. But what is also interesting is that you have this clinical measurement that can be used to evaluate two entirely different diseases at the same time, which is an efficiency that should benefit both the patients and healthcare providers."

In the editorial, he and Dr. Kazem Rahimi, also with the University of Oxford, conclude, "Perhaps it is high time to establish how bone health affects vasculature and understand the underlying pathophysiology that links osteoporotic and atherosclerotic conditions."

SOURCE: and Heart, online May 7, 2021.