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Relationship of bone mineral density with valvular and annular calcification in community-dwelling older people: The Cardiovascular Health Study

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Abstract

Summary

Associations between bone mineral density and aortic valvular, aortic annular, and mitral annular calcification were investigated in a cross-sectional analysis of a population-based cohort of 1497 older adults. Although there was no association between continuous bone mineral density and outcomes, a significant association between osteoporosis and aortic valvular calcification in men was found.

Introduction

The process of cardiac calcification bears a resemblance to skeletal bone metabolism and its regulation. Experimental studies suggest that bone mineral density (BMD) and valvular calcification may be reciprocally related, but epidemiologic data are sparse.

Methods

We tested the hypothesis that BMD of the total hip and femoral neck measured by dual-energy X-ray absorptiometry (DXA) is inversely associated with prevalence of three echocardiographic measures of cardiac calcification in a cross-sectional analysis of 1497 older adults from the Cardiovascular Health Study. The adjusted association of BMD with aortic valve calcification (AVC), aortic annular calcification (AAC), and mitral annular calcification (MAC) was assessed with relative risk (RR) regression.

Results

Mean (SD) age was 76.2 (4.8) years; 58% were women. Cardiac calcification was highly prevalent in women and men: AVC, 59.5 and 71.0%; AAC 45.1 and 46.7%; MAC 42.8 and 39.5%, respectively. After limited and full adjustment for potential confounders, no statistically significant associations were detected between continuous BMD at either site and the three measures of calcification. Assessment of WHO BMD categories revealed a significant association between osteoporosis at the total hip and AVC in men (adjusted RR compared with normal BMD = 1.24 (1.01–1.53)). In graded sensitivity analyses, there were apparent inverse associations between femoral neck BMD and AVC with stenosis in men, and femoral neck BMD and moderate/severe MAC in women, but these were not significant.

Conclusion

These findings support further investigation of the sex-specific relationships between low BMD and cardiac calcification, and whether processes linking the two could be targeted for therapeutic ends.

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Acknowledgements

This research was supported by contracts HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, and N01HC85086, and grants U01HL080295 and U01HL130114 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by R01AG023629 from the National Institute on Aging (NIA). This work was furthermore supported by NIH/National Center for Advancing Translational Science (NCATS) Einstein/Montefiore CTSA Grant Number UL1TR001073. A full list of principal CHS investigators and institutions can be found at http://www.chs-nhlbi.org/pi.htm. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Cardiovascular Clinical Research Unit, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Ave, Bronx, NY, 10461, USA

    Daniele Massera, Shuo Xu, Anna E. Bortnick & Jorge R. Kizer

  2. University of Washington, Seattle, WA, USA

    Traci M. Bartz

  3. University of California San Diego, San Diego, CA, USA

    Joachim H. Ix & David S. Owens

  4. University of Colorado Denver, Aurora, CO, USA

    Michel Chonchol

  5. St. Francis Hospital, Roslyn, NY, USA

    Eddy Barasch

  6. Hackensack University Medical Center, Hackensack, NJ, USA

    Julius M. Gardin

  7. University of Maryland, Baltimore, MD, USA

    John S. Gottdiener

  8. University of California Davis, Sacramento, CA, USA

    John R. Robbins

  9. New York Academy of Medicine, New York, NY, USA

    David S. Siscovick

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  1. Daniele Massera
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Correspondence to Jorge R. Kizer.

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The CHS Coordinating Center and all field centers received institutional review board approval for the study and participants gave informed consent. The present study was approved by the institutional review board at Albert Einstein College of Medicine.

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Massera, D., Xu, S., Bartz, T.M. et al. Relationship of bone mineral density with valvular and annular calcification in community-dwelling older people: The Cardiovascular Health Study. Arch Osteoporos 12, 52 (2017). https://doi.org/10.1007/s11657-017-0347-y

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