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The association of microvascular disease and endothelial dysfunction with vertebral trabecular bone mineral density

The MESA study

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Abstract

Summary

Retinopathy and albuminuria are associated with hip fracture risk. We investigated whether these disorders and endothelial dysfunction (which underlies microvascular diseases) were associated with low trabecular bone density. No significant associations were found, suggesting that microvascular diseases are not related to fracture risk through low trabecular bone density.

Purpose

Microvascular diseases of the eye, kidney, and brain are associated with endothelial dysfunction and increased hip fracture risk. To explore the basis for higher hip fracture risk, we comprehensively examined whether markers of microvascular disease and/or endothelial dysfunction are related to trabecular bone mineral density (BMD), a proximate risk factor for osteoporotic fractures.

Methods

Among 6814 participants in the Multi-Ethnic Study of Atherosclerosis study (MESA), we derived thoracic vertebral trabecular BMD from computed tomography of the chest and measured urine albumin to creatinine ratios (UACR), retinal arteriolar and venular widths, flow mediated dilation (FMD) of the brachial artery after 5 min of ischemia; and levels of five soluble endothelial adhesion markers (ICAM-1, VCAM-1, L-selectin, P-selectin, and E-selectin). Linear regression models were used to examine the association of trabecular BMD with markers of microvascular disease and with markers of endothelial dysfunction.

Results

We observed no significant associations of UACR, retinal arteriolar or venular widths, or FMD with BMD. We also observed no statistically significant association of spine trabecular BMD with levels of endothelial adhesion markers. Men and women had largely similar results.

Conclusion

We conclude that there is little evidence to connect thoracic spine trabecular BMD to microvascular disorders or to endothelial dysfunction among multi-ethnic middle-aged and older adults. Other factors beyond trabecular BMD (e.g., bone quality or predisposition to falling) may be responsible for the associations of microvascular disease with osteoporotic fractures.

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Acknowledgements

The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.

Funding

This research was supported by R01HL146666 and 2R42AR070713 and MESA was supported by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N9 2020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the National Heart, Lung, and Blood Institute, and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the National Center for Advancing Translational Sciences.

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Authors and Affiliations

  1. Division of Endocrinology, Kaiser Permanente of Georgia, 3650 Steve Reynolds Blvd, Duluth, GA, 30096, USA

    Joshua I. Barzilay

  2. Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA

    Joshua I. Barzilay

  3. Division of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA

    Petra Buzkova

  4. Department of Epidemiology, Mayo Clinic, Rochester, MN, USA

    Suzette J. Bielinski

  5. Office of Vision Health and Population Sciences, National Eye Institute, National Institutes of Health, Bethesda, MD, USA

    Mary Frances Cotch

  6. Division of Nephrology, University of Washington, Seattle, WA, USA

    Bryan Kestenbaum

  7. Department of Epidemiology, Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA

    Thomas R. Austin

  8. Division of Rheumatology, Medical College of Georgia, Augusta, GA, USA

    Laura Carbone

  9. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Brookline, MA, USA

    Kenneth J. Mukamal

  10. Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, CA, USA

    Matthew J. Budoff

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  1. Joshua I. Barzilay
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Correspondence to Joshua I. Barzilay.

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Barzilay, J.I., Buzkova, P., Bielinski, S.J. et al. The association of microvascular disease and endothelial dysfunction with vertebral trabecular bone mineral density. Osteoporos Int (2024). https://doi.org/10.1007/s00198-024-07152-y

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