Table 2

Prospective studies investigating relationship low BMD and CV disease

Study

Study population (years follow-up)

Number of cases (% women)

Postmenopausal women

CV disease excluded

Mean age (years)

Race

Outcome osteoporosis

Outcome CV disease

Results #

Quality (x nee)


Mussolino, 2007 [69]

Population-based

(9)

5,272 (NA)

NA

Yes

60.9 to 69.4

Caucasian (NA%), black and Mexican-American

BMD proximal femur by DXA

CV and stroke mortality by death certificates

Women:

BMD and CV mortality RR: 1.26 (95% CI 0.88 to 1.80)

BMD and stroke mortality: RR: 1.34 (95% CI 0.86 to 2.07)

Men:

BMD and CV mortality: RR: 1.05 (95% CI 0.79 to 1.39)

BMD and stroke mortality: RR; 0.73 (95% CI 0.43 to 1.23)

3

Farhat, 2007 [6]

Population-based

(5.4)

2,310 (55%)

Yes

Yes

73.5

Caucasian (58%) and black

BMD total hip, femoral neck and trochanter by DXA

BMD spine by CT-scans

Incident CV disease by hospital records and death certificates

Women: BMD fem neck and incident CV disease: HR: 1.24 (95% CI 1.02 to 1.52)

Men: BMD fem neck and incident CV disease:

HR: 1.04 (95% CI 0.89 to 1.21)

3

Tamaki, 2009 [75]

Population-based

(10)

609 (100%)

Yes (60%)

No

55.9

Japanese

BMD lumbar spine and total hip by DXA

IMT values

<10 YSM:

IMT OP vs normal bone mass: 1.55 vs 1.19 (P < 0.05)

‚Č•YSM:

IMT OP vs normal bone mass: 1.53 vs 1.28 (P < 0.05)

3

Browner, 1991 [5]

Population-based

(2.8)

9,704 (100%)

Yes

No

NA

Caucasian (99%) and Asian

BMD distal radius, prox radius and calcaneus by single photon absorptiometry

Overall mortality and CV mortality by death certificates

BMD and risk overall mortality: RR: 1.22 (95% CI 1.01 to 1.47)

BMD and stroke mortality: RR: 1.75 (95% CI 1.15 to 2.65)

BMD and CV mortality: RR: 1.17 (95% CI 0.92 to 1.51)

3

Trone, 2007 [68]

Population-based

(7.6)

1,580 (60%)

Yes (NA %)

No

71.9

Caucasian

Prevalence vertebral fracture by lateral spine radiographs

Overall mortality by death certificates

Women: prevalent vertebral fracture and overall mortality: HR: 1.15 (95% CI 0.83 to 1.59)

Men: prevalent vertebral fracture and overall mortality: HR: 0.98 (95% CI 0.55 to 1.46)

3

Kado, 2000 [64]

Population-based

(3.5)

6,018 (100%)

Yes

No

76.5

Caucasian

BMD total hip by DXA

Overall and CV mortality by death certificates

BMD and overall mortality: RH: 1.3 (95% CI 1.1 to 1.4)

BMD and CV mortality: RH: 1.3 (95% CI 1.0 to 1.9)

4

Trivedi, 2001 [67]

Population-based

(6.7)

1,002 (0%)

No women included

No

69.7

NA

BMD total hip by DXA

Overall and CV mortality by death certificates

BMD and overall mortality: RR: 0.79 (95% CI 0.65 to 0.97)

BMD and CV mortality: RR: 0.72 (95% CI 0.56 to 0.93)

4

Tanko, 2005 [76]

Clinic-based

(4)

2,576 (100%)

Yes

No

66.5

NA

BMD lumbar spine and femoral neck by DXA

Incidence CV events self-reported and confirmed by primary documents

HR: 3.9 (95% CI 2.0 to 7.7)

4

Pinheiro, 2006 [66]

Population-based

(5)

208 (100%)

Yes

No

75.1

Caucasian

BMD lumbar spine, femoral neck and trochanter by DXA

Overall and CV mortality by death certificates

BMD and overall mortality: HR: 1.44 (95% CI 1.06 to 2.21)

BMD and CV mortality: HR: 1.28 (95% CI 1.08 to 2.26)

4

Johansson, 1998 [7]

Population-based

(7)

1,468 (56%)

Yes

No

74.0

Caucasian

BMD calcaneus by DPA

Overall mortality by death certificates

Women: RR: 1.19 (95% CI 1.02 to 1.39)

Men: RR: 1.23 (95% CI 1.10 to 1.41)

4

Mussolino, 2003 [65]

Population-based

(18.5)

3,402 (NA)

NA

Yes

NA

Caucasian (87%) and black

BMD phalangeal by single photon absorption

Stroke mortality by death certificates

Women: RR: 1.01 (95% CI 0.86 to 1.19)

Men: RR: 1.13 (95% CI 0.93 to 1.38)

Blacks: RR : 0.93 (95% CI 0.72 to 1.21)

4

Samelson, 2004 [70]

Population-based

(30)

2,059 (60%)

Yes (85,3-94%)

Yes

60.2

NA

Second MCA by radiogrammatry

Incidence coronary heart disease by hospital records and death certificates

Women: HR: 0.73 (95% CI 0.53 to 1.00)

Men: HR: 1.14 (95% CI 0.84 to 1.56)

4

Kiel, 2001 [77]

Population-based

(25)

554 (66%)

NA

No

54.4

NA

Second MCA by radiogrammetry

AC by radiograph of the lumbar spine

Women: Sign association % change in MCA and change AC index (P = 0.01)

Men: No association % change MCA and change AC index (P = 0.50)

4

Browner, 1993 [62]

Population-based

(1.98)

4,024 (100%)

Yes

Yes

NA

Caucasian

BMD distal radius and calcaneus by single photon absorptiometry

Incident strokes by hospital records and death certificates

HR: 1.31 (95% CI 1.03 to 1.67)

5

Von der Recke, 1999 [8]

Clinic-based

(17)

1,063 (100%)

Yes

Yes

50 and 70

NA

BMD distal forearm by single photon absorptiometry with 125I source

CV mortality by death certificates, hospital records and autopsy reports

Early menopause: RR: 2.3 (95% CI 1.0 to 5.3)

Late menopause: RR: 1.3 (95% CI 0.9 to 1.8)

5

Silverman, 2004 [71]

Clinic-based

(3)

2,565 (100%)

Yes

No

67

Caucasian (95.8%)

Prevalence vertebral fracture by lateral spine radiographs

Incident CV event self-reported and confirmed by primary documents

CV event rate women with prevalent vertebral fracture vs no vertebral fracture: 15.1 vs 8.3 (P = 0.55)

5

Varosy, 2003 [73]

Clinic-based

(4.1)

2,763 (100%)

Yes

Yes

NA

NA

Prevalent and incident skeletal fracture self-reported. Incident fractures were confirmed by radiological reports

Incident coronay event by hospital records

HR: 0.75 (95% CI 0.57 to 0.98)

5

Gonzales-Macias, 2009 [63]

Clinic-based

(3)

5,201 (100%)

Yes

No

72.3

Caucasian

eBMD calcaneus by QUS

Overall and CV mortality by medical records

eBMD and overall mortality: HR: 1.19 (95% CI 0.97 to 1.45)

eBMD and CV mortality: HR: 1.39 (95% CI 1.15 to 1.66)

6


#adjusted for age; AC, aortic calcification; BMD, bone mineral density; DPA, dual photon absorptiometry; DXA, dual-energy x-ray absorptiometry; IMT, intima media thickness; MCA, metacarpal relative cortical area; NA, not available; QUS, quantitative ultrasonography; YSM, years since menopause.

den Uyl et al. Arthritis Research & Therapy 2011 13:R5   doi:10.1186/ar3224

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