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Low BMD Associated with Higher Coronary Plaque Burden

Is there a relationship between osteoporosis, cardiovascular disease, and mortality? This new study aimed to find out. 

Naser Ahmadi, MD, PhD, and fellow researches at the University of California Los Angeles David Geffen School of Medicine found that osteoporosis is associated with more severe coronary artery calcium build up. Thumb through the slides above for details on the study and take home points for physicians.For more information: Ahmadi N, Mao SS, Hajsadeghi F, et al. The relation of low levels of bone mineral density with coronary artery calcium and mortality. Osteoporos Int. 2018;1-8. 

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Low BMD Associated with Higher Coronary Plaque Burden

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Osteoporosis and Atherosclerosis. Authors of the this study aimed to investigate the relationship between BMD, CAC, and mortality. 

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The Study. 5590 patients without known coronary artery disease or metabolic bone disorders underwent nonenhanced cardiac CT imaging over an 8 year period to determine BMD levels and CAC burden. 

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The Results. There were no significant differences in mean BMD levels in men [181 ± 20, median 180] vs women [180 + 20, median 180] (p = 0.8). The survival rate of subjects with CAC >0 significantly decreased from 93% in subjects within normal BMD levels to 84.6% in those with low BMD levels (p<.05). 

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Results (continued). The relative risk of death was 8.01-fold higher in subjects with low BMD levels and CAC >0 vs those within normal BMD levels and CAC=0. The risk of death increased proportionally with each category increase in CAC and low BMD levels vs those within normal BMD levels and CAC=0 (p<.05). 

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Take Home Messages: 

  • Physicians should be aware of the inverse relationship between BMD and CAC. 
  • The same inflammatory cytokines present and implicated coronary artery disease may be responsible for poor bone formation. 
  • Physicians should consider patients with osteoporosis at higher risk for CV disease and mortality. 
  • Patients with osteoporosis should be screened for CV disease and treated appropriately. 
  • Appropriate to screen for osteoporosis and CAC simultaneously to limit cost and radiation dose. 
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