High hip fracture risk in men with severe aortic calcification: MrOS study

Pawel Szulc, Terri Blackwell, John T. Schousboe, Douglas C. Bauer, Peggy Cawthon, Nancy E. Lane, Steven R. Cummings, Eric Orwoll, Dennis M. Black, Kristine E. Ensrud

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

A significant link between cardiovascular disease and osteoporosis is established in postmenopausal women, but data for men are scarce. We tested the hypothesis that greater severity of abdominal aortic calcification (AAC) was associated with an increased risk of nonspine fracture in 5994 men aged ≥65 years. AAC was assessed on 5400 baseline lateral thoracolumbar radiographs using a validated visual semiquantitative score. Total hip bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry. Incident nonspine fractures were centrally adjudicated. After adjustment for age, body mass index (BMI), total hip BMD, fall history, prior fracture, smoking status, comorbidities, race, and clinical center, the risk of nonspine fracture (n = 805) was increased among men with higher AAC (hazard ratio [HR] quartile 4 [Q4] [AAC score ≥9] versus quartile 1 [Q1] [0-1], 1.36; 96% confidence interval [CI], 1.10-1.68). This association was due to an increased risk of hip fracture (n = 178) among men with higher AAC (HR Q4 versus Q1, 2.33; 95% CI, 1.41-3.87). By contrast, the association between AAC and the risk of nonspine, nonhip fracture was weaker and not significant (HR Q4 versus Q1, 1.22; 95% CI, 0.96-1.55). The findings regarding higher AAC and increased risk of fracture were not altered in additional analyses accounting for degree of trauma, estimated glomerular filtration rate, presence of lumbar vertebral fractures (which may bias AAC assessment), preexisting cardiovascular disease, ankle brachial index, or competing risk of death. Thus, in this large cohort of elderly men, greater AAC was independently associated with an increased risk of hip fracture, but not with other nonspine fractures. These findings suggest that AAC assessment may be a useful method for identification of older men at high risk of hip fracture.

Original languageEnglish (US)
Pages (from-to)968-975
Number of pages8
JournalJournal of Bone and Mineral Research
Volume29
Issue number4
DOIs
StatePublished - 2014

Fingerprint

Hip Fractures
Pelvic Bones
Confidence Intervals
Bone Density
Cardiovascular Diseases
Ankle Brachial Index
Preexisting Condition Coverage
Photon Absorptiometry
Glomerular Filtration Rate
Osteoporosis
Comorbidity
Body Mass Index
Smoking
History
Wounds and Injuries

Keywords

  • ABDOMINAL AORTIC CALCIFICATION
  • HIP FRACTURE
  • MEN

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

Cite this

Szulc, P., Blackwell, T., Schousboe, J. T., Bauer, D. C., Cawthon, P., Lane, N. E., ... Ensrud, K. E. (2014). High hip fracture risk in men with severe aortic calcification: MrOS study. Journal of Bone and Mineral Research, 29(4), 968-975. https://doi.org/10.1002/jbmr.2085

High hip fracture risk in men with severe aortic calcification : MrOS study. / Szulc, Pawel; Blackwell, Terri; Schousboe, John T.; Bauer, Douglas C.; Cawthon, Peggy; Lane, Nancy E.; Cummings, Steven R.; Orwoll, Eric; Black, Dennis M.; Ensrud, Kristine E.

In: Journal of Bone and Mineral Research, Vol. 29, No. 4, 2014, p. 968-975.

Research output: Contribution to journalArticle

Szulc, P, Blackwell, T, Schousboe, JT, Bauer, DC, Cawthon, P, Lane, NE, Cummings, SR, Orwoll, E, Black, DM & Ensrud, KE 2014, 'High hip fracture risk in men with severe aortic calcification: MrOS study', Journal of Bone and Mineral Research, vol. 29, no. 4, pp. 968-975. https://doi.org/10.1002/jbmr.2085
Szulc P, Blackwell T, Schousboe JT, Bauer DC, Cawthon P, Lane NE et al. High hip fracture risk in men with severe aortic calcification: MrOS study. Journal of Bone and Mineral Research. 2014;29(4):968-975. https://doi.org/10.1002/jbmr.2085
Szulc, Pawel ; Blackwell, Terri ; Schousboe, John T. ; Bauer, Douglas C. ; Cawthon, Peggy ; Lane, Nancy E. ; Cummings, Steven R. ; Orwoll, Eric ; Black, Dennis M. ; Ensrud, Kristine E. / High hip fracture risk in men with severe aortic calcification : MrOS study. In: Journal of Bone and Mineral Research. 2014 ; Vol. 29, No. 4. pp. 968-975.
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abstract = "A significant link between cardiovascular disease and osteoporosis is established in postmenopausal women, but data for men are scarce. We tested the hypothesis that greater severity of abdominal aortic calcification (AAC) was associated with an increased risk of nonspine fracture in 5994 men aged ≥65 years. AAC was assessed on 5400 baseline lateral thoracolumbar radiographs using a validated visual semiquantitative score. Total hip bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry. Incident nonspine fractures were centrally adjudicated. After adjustment for age, body mass index (BMI), total hip BMD, fall history, prior fracture, smoking status, comorbidities, race, and clinical center, the risk of nonspine fracture (n = 805) was increased among men with higher AAC (hazard ratio [HR] quartile 4 [Q4] [AAC score ≥9] versus quartile 1 [Q1] [0-1], 1.36; 96{\%} confidence interval [CI], 1.10-1.68). This association was due to an increased risk of hip fracture (n = 178) among men with higher AAC (HR Q4 versus Q1, 2.33; 95{\%} CI, 1.41-3.87). By contrast, the association between AAC and the risk of nonspine, nonhip fracture was weaker and not significant (HR Q4 versus Q1, 1.22; 95{\%} CI, 0.96-1.55). The findings regarding higher AAC and increased risk of fracture were not altered in additional analyses accounting for degree of trauma, estimated glomerular filtration rate, presence of lumbar vertebral fractures (which may bias AAC assessment), preexisting cardiovascular disease, ankle brachial index, or competing risk of death. Thus, in this large cohort of elderly men, greater AAC was independently associated with an increased risk of hip fracture, but not with other nonspine fractures. These findings suggest that AAC assessment may be a useful method for identification of older men at high risk of hip fracture.",
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