Oral Presentation 1st Asia Pacific Herbert Fleisch Workshop 2025

Components of osteoporosis and long-term cardiovascular disease outcomes (#10)

Cassandra Smith 1 2 , Marc Sim 1 2 , Jack Dalla Via 3 , Abadi K Gebre 1 , Kun Zhu 2 , Wai H Lim 1 , Richard L Prince 2 , Gemma Figtree 4 5 , Andrew JS Coats 6 , John T Schousboe 7 8 , Joshua R Lewis 1 2 , William D Leslie 9
  1. School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
  2. Medical School, University of Western Australia, Perth, WA, Australia
  3. Institute for Physical Activity and Nutrition (IPAN), Deakin University, Melbourne, VIC, Australia
  4. Northern Clinical School, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Aus
  5. Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
  6. Heart Research Institute, Sydney Australia
  7. Park Nicollet Clinic and HealthPartners Institute, HealthPartners, Minneapolis, USA
  8. Division of Health Policy and Management, University of Minnesota, Minneapolis, USA
  9. Departments of Medicine and Radiology, University of Manitoba, Winnipeg, Canada

Aims: Osteoporosis has been linked to increased cardiovascular disease (CVD) risk. However, the long-term risk of CVD outcomes associated with components of osteoporosis (T-scores and osteoporotic fractures) remains unclear. We explored whether osteoporosis was associated with increased long-term risk of CVD mortality in 1,117 older women (cohort 1, mean±SD age of 75.0±2.6 years), then performed a replication study in a registry-based cohort of 80,483 people reflective of routine practice (cohort 2, 66.5±9.6 years, 94.7% female).

Methods: Bone mineral density (BMD) was assessed by dual-energy x-ray absorptiometry. Osteoporosis defined by a T-score of ≤-2.5 and osteopenia as T-score between -2.5 and -1.0. Mortality/event data obtained from linked health data. Models adjusted for CVD risk factors.

Results: In cohort 1, 59.7% had osteopenia at any site (total hip or femoral neck) and 27.7% had osteoporosis with 166 deaths (14.9%) over 15-years due to CVD. Compared to having normal BMD, osteoporosis at any site was associated with 92% increased risk for 15-year CVD mortality (Fig 1a). In cohort 2, 50.4% had osteopenia at any site (total hip, femoral neck or lumbar spine) and 25.4% had osteoporosis with 20,047 (24.9%) major adverse cardiovascular events (MACE) over 8.5 years. Compared with normal BMD, having osteoporosis at any site was associated with a 17-35% increase MACE and its outcomes, hospitalized acute myocardial infarction, ischemic cerebrovascular disease and all-cause mortality (Fig 1b). Regional differences were observed with a site-specific relationship with MACE, the strongest association was observed at the hip.

Conclusion: Osteoporosis, defined as low bone mineral density or previous fracture, is associated with higher long-term risk for CVD events. Further work is needed to identify whether this relationship is causal and to identify potential mechanisms. Low BMD may offer a novel strategy to screen for higher risk older women where CVD risk remains underrecognized.

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