Table 3

Cross-sectional studies investigating relationship CV disease and low BMD

Study

Study population

Number of cases

% women

Outcome bone mass

Outcome CV disease

Main results #


Frye, 1992 [35]

Population-based

200

100%

BMD lumbar spine and hip by single photon absorptiometry

AC by x-ray

Association AC and BMD lumbar spine: β-2.213 (P < 0.05)

Association AC and BMD hip: β-0.661 (NS)

Barengolts, 1998 [32]

Clinic-based

45

100%

BMD lumbar spine and hip by DXA

Coronary calcium score by EBT

Correlation BDM hip and calcium score: r-0.34 (P = 0.022)

Correlation BMD spine and calcium score: r-0.28 (P = 0.056)

Jorgensen, 2001 [27]

Clinic-based

63

52%

BMD femoral neck by DXA

Incident stroke

Women:

OR: 6.6 (95% CI 1.8 to 24.8)

Men:

OR: 0.6 (95% CI 0.1 to 2.3)

Aoyagi, 2001 [40]

Population-based

524

100%

BMD distal and proximal radius, calcaneus single photon absorptiometry by sinlge photon absorptiometry

AC by x-ray

BMD distal radius and AC: OR: 1.1 (95% CI 0.9 ro 1.3)

BMD calcaneus and AC: OR: 1.1 (0.9 to 1.3)

Van der Klift, 2002 [29]

Population-based

5,268

57%

BMD lumbar spine and hip by DXA

PAD by ABI

Women:

PAD and BMD hip: OR: 1.35 (95% CI 1.02 to 1.79)

Men:

PAD and BMD hip: OR: 0.89 (95% CI 0.64 to 1.23)

Tanko, 2003 [39]

Population-based

963

100%

BMD hip and lumbar spine by DXA

AC by x-ray

AC and BMD hip: β-0.10, 9 (P = 0.004)

Hirose, 2003 [56]

Clinic-based

7,865

9%

OSI calcaneus

baPWV

Women: β-0.11 (P < 0.01)

Men: β-0.07 (P < 0.01)

Pennisi, 2004 [50]

Clinic-based

36

44%

BMD total body, lumbar spine, and hip by DXA and calcaneus by QUS

IMT and presence of plaque in carotid artery

63% patients with BMD spine T <-1

93% patients with BMD hip T <-1

Jorgensen, 2004 [47]

Population-based

5,296

52%

BMD distal radius by single x-ray absorptiometry

IMT and prevalent plaque

BMD and IMT: NS

BMD and prevalent plaque: OR: 0.90 (95% CI 0.75 to 1.07)

BMD and echogenic plaque: OR: 0.51 (95% CI 0.31 to 0.83)

Montalcini, 2004 [49]

Clinic-based

157

100%

BMD calcaneus by QUS

IMT

BMD and IMT: NS

Magnus, 2005 [23]

Population-based

5,050

36%

BMD hip by DXA

Self reported CV events

Women:

OR: 1.22 (0.80 to 1.86)

Men:

OR: 1.39 (95% CI 1.03 to 1.87)

Bakhireva, 2005 [31]

Population-based

366

51%

BMD lumbar spine and hip by DXA

CAC by CT scan

Women:

BMD hip and CAC: OR: 0.69 (95% CI 0.51 to 0.93)

Men:

BMD hip and CAC: OR: 1.03 (0.75 to 1.41)

Wong, 2005 [30]

Population-based

3,998

50%

BMD lumbar spine and hip by DXA

PAD by ABI

Per SD increase in ABI sign associated with hip BMD:

0.5 (95% CI 0.02 to 0.9)

Yamada, 2005 [53]

Clinic-based

260

59%

BMD lumbar spine by DXA and OSI calcanues

IMT carotid artery and femoral artery

BMD lumbar spine and FA-IMT: ρ-0.117 (P < 0.005)

Farhat, 2006 [34]

Population-based

490

100%

vBMD spine by CT scan

AC and CAC by CT scan

AC and BMD: OR: 1.68 (95% CI 1.06 to 2.68)

CAC and BMD: OR: 1.19 (95% CI 0.81 to 1.74)

Farhat, 2006 [19]

Population-based

1,489

51%

BMD hip by DXA

vBMD lumbar spine by QCT

Prevalent CV disease self reported Prevalent PAD by ABI

Women:

Prevalent CV disease and BMD hip: OR: 1.22 (95% CI 1.03 to 1.43)

PAD and BMD hip: NS Men:

Prevalent CV disease and BMD hip: NS

PAD and BMD hip: OR: 1.39 (95% CI 1.03 to 1.84)

Yamada, 2006 [54]

Population-based

149

100%

BMD lumbar spine by DXA and vBMD calcaneus by QCT

IMT and PWV

FA-IMT and BMD spine: β-0.067 (P < 0.05)

PWV and BMD spine: NS

Sumino, 2006 [60]

Clinic-based

315

100%

BMD lumbar spine by DXA

baPWV

Association baPWV and BMD: β-0.265 (P = 0.002)

Sinnot, 2006 [43]

Clinic-based

480

65%

BMD lumbar spine by QCT

Calcium score by CT-scan

No correlation CAD and BMD in women and men

Shaffer, 2007 [51]

Population-based

870

61%

BMD lumbar spine, hip and distal radius by DXA

IMT

Women >60 years:

IMT and BMD spine: β-73.0 (P < 0.001)

IMT and BMD hip: β-62.4 (P < 0.001)

Men >60 years:

IMT and BMD radius: β-27.0 (P < 0.001)

Sumino, 2007 [61]

Clinic-based

85

100%

BMD lumbar spine by DXA

Brachial arterial endothelial function (FMD)

Correlation FMD and BMD: r .034 (P < 0.01)

Association FMD and BMD: β 0.40 (P < 0.01)

Hyder, 2007 [36]

Clinic-based

365

64%

BMD lumbar spine by CT-scan

Atherosclerotic calcium in carotid, coronary and iliac arteries by CT-scan

Women:

Calcium score aorta and BMD: OR: 3.14 (95% CI 1.55 to 6.38) Calcium score iliac arteries and BMD: OR: 2.20 (95% CI 1.13 to 4.29)

Men:

Calcium score carotid and BMD: OR: 2.85 (95% CI 1.02 to 7.96)

Calcium score aorta and BMD: OR: 5.90 (95% CI 1.78 to 19.6)

Shen, 2007 [42]

Population-based

682

56%

BMD lumbar spine and hip by DXA

CAC by CT scan

CAC and BMD spine: -0.105 ± 0.132 (NS)

CAC and BMD hip: 0.022 ± 0.142 (NS)

Sioka, 2007 [24]

Clinic-based

21

0%

BMD lumbar spine and hip by DXA

CAD by angiography

BMD in severe CAD vs no CAD: 77.8% vs 37.5%, P =?

Sumino, 2008 [52]

Clinic-based

175

100%

BMD lumbar spine by DXA

IMT

BMD and IMT β-0.313 (P = 0.001)

Kim, 2008 [48]

Clinic-based

194

100%

BMD lumbar spine and hip by DXA

Prevalent vertebral fracture

IMT and prevalent plaque

BMD and IMT: NS

BMD and plaque: NS

Vertebral fracture and plaque: OR: 2.8 (95% CI 1.17 to 7.12)

Frost, 2008 [45]

Clinic-based

54

100%

Lumbar spine and hip by DXA

IMT and PWV

BMD spine and IMT: r -.025 (P = 0.26)

BMD hip and IMT: r-0.17 (NS)

BMD and PWV: NS

Mangiafico, 2008 [57]

Clinic-based

182

100%

BMD lumbar spine and hip DXA

PWA (AIx and PWV)

BMD hip and AIx: β-5.46 (P < 0.0001)

BMD spine and Aix: β-3.29 (P < 0.0001)

Tekin, 2008 [25]

Clinic-based

227

100%

BMD lumbar spine by DXA

Prevalence CAD

CAD and low BMD: OR: 0.68 (95% CI 0.39 to 1.28)

Broussard, 2008 [18]

Population-based

3,881

51%

BMD total femur by DXA

Framingham CHD risk score by Framingham CHD prediction model

Women:

moderate CHD risk and low BMD: OR: 1.45 (95% CI 1.03 to 2.06)

high CHD risk and low BMD: OR: 1.73 (95% CI 1.12 to 2.66)

Men: NS

Chow, 2008 [41]

Population-based

693

54%

vBMD lumbar spine and hip by QCT and vBMD distal radius by HRpQCT

AC by CT-scan

Women: NS

Men: NS

Hyder, 2009 [37]

NA

1,909

50%

vBMD lumbar spine by CT scan

CAC and AAC score

Women:

vBMD and CAC (P-trend <0.002) vBMD AND AAC (P-trend <0.004)

Men:

vBMD and CAC (P-trend <0.034)

vBMD and AAC (P-trend <0.001)

Hmamouchi, 2009 [46]

Clinic-based

72

100%

BMD lulmbar spine and hip by DXA

IMT in carotid artery and femoral artery

CA-IMT and BMD hip: r-0.330 (P < 0.05)

FA-IMT and BMD hip: NS

IMT and BMD lumbar spine: NS

Mikumo, 2009 [58]

Clinic-based

143

100%

BMD lumbar spine by DXA

PWV

BMD and PWV: r-99.78 (NS)

Marcowitz, 2005 [20]

Clinic-based

209

88%

Lumbar spine, hip and distal radius by DXA

CAD

Osteoporosis: OR: 5.58 (95% CI 2.59 to 12.0) for CAD

Ness, 2006 [38]

Clinic-based

1,000

100%

Diagnosis osteoporosis or osteopenia by electronic medical records

AVD

Prevalence AVD osteoporotis vs osteopenia:

60% vs 35% (P < 0.001)

Prevalence AVD osteoporis vs normal bone mass:

60% vs 22% (P < 0.001)

Gupta, 2006 [78]

Clinic-based

101

100%

BMD lumbar spine and total hip by DXA

Prevalent CV disease

Prevalent CV disease in low BMD vs normal BMD:

61% vs 38% (P < 0.025)

Mangifico, 2006 [28]

Clinic-based

345

100%

BMD lumbar spine and femoral neck by DXA

PAD by ABI

PAD and BMD lumbar spine: OR: 1.01 (95% CI 0.97 to 1.05)

PAD and BMD hip: OR: 0.20 (95% CI 0.05 to 0.70)

Erbilen, 2007 [33]

Clinic-based

74

0%

BMD lumbar spine and hip by DXA

CAD

Association BMD and CAD:

OR: 5.4 (95% CI 1.66 to 17.49)

Sennerby, 2007 [21]

Clinic-based

1,327

100%

Incident hip fracture by X-ray and hospital record

Prevalent CV disease by questionnaire

OR: 2.38 (95% CI 1.92 to 2.94)

Varma, 2008 [22]

Clinic-based

198

74%

Lumbar spine and hip by DXA

Obstructive CAD

Prevalence CAD osteoporosis vs osteopenia:

76% vs 68% (P < 0.01)

Prevalence CAD osteoporosis vs normal bone mass:

76% vs 47% (P < 0.005)

Seo, 2009 [59]

Clinic-based

253

100%

BMD lumbar spine and hip by DXA

baPWV

Sign association BMD hip and baPWV:

Β-0.123 (P < 0.05)

Pouwels, 2009 [16]

Clinic-based

6,763

73%

Incident hip fracture

Incident stroke by ICD 9 code

Risk hip fracture after stroke

Women: OR: 2.12 (95% CI 1.73 to 2.59)

Men: OR: 1.63 (95% CI 1.17 to 2.28)


#adjusted for confounders; BMD, bone mineral density; AC, aortic calcification; DXA, dual-energy x-ray absorptiometry; PAD, peripheral arterial disease; ABI, ankle brachial index; OSI, osteosono assessment index; baPWV, brachial-ankle pulse wave velocity; IMT, intimal medial thickness; CAC, coronary artery calcium; QCT, quantitative computerized tomography; PWV, pulse wave velocity; CAD, coronary artery disease; PWA, pulse wave analysis; AIx, augmentation index; CHD, coronary hearth disease; AVD, atherosclerotic vascular disease.

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

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