The association between low bone mineral density and coronary artery calcification in osteoporotic and non-osteoporotic patients in a tertiary center in Saudi Arabia

Risk Factors Associated With Coronary Disease in Saudi Arabia: A Comprehensive Review

Coronary artery disease (CAD) has become a major health challenge across the globe and is one of the major causes of mortality and morbidity in several countries. In Saudi Arabia, recent studies have emphasized the burden of CAD. Therefore, in this study, we aim to assess the risk factors associated with CAD in Saudi Arabia. The Population, Intervention, Comparison, and Outcome (PICO) model was used to refine the research question, which defined patients with CAD and identified risk factors and prevention strategies. PubMed, Web of Science, and Google Scholar were searched from January 1, 2010, until December 1, 2024. The common risk factors were diabetes, hypertension, obesity, and smoking, indicating their significant impact on health outcomes and the urgency for focus prevention strategies such as education and routine clinical screening. The risk factors contributing to CAD emphasize the need for targeted public health intervention and improvement in the management of risk factors in addition to specific health education content to improve healthy habits in the community.

The potential protective role of vitamin D and calcium supplements in reducing cardiovascular disease risk among elderly patients with osteopenia

BACKGROUND

Cardiovascular disease and low bone mineral density are major health problems in the elderly. These two conditions are considered independent of each other and age-related diseases. The aim of this study is to investigate the association between low bone mineral density (BMD) and cardiovascular disease (CVD) incidents, and the effect of vitamin D and calcium supplement on the incidence of CVD in patients with low BMD.

METHODS

A total of 1047 patients (597 females/450 males) with the age of 65 years and more were diagnosed with osteopenia for 13 years or more. The study also included 220 patients (107 females/113 males) with osteopenia who already took calcium and vitamin D continually since their diagnosis. BMD was measured by dual-energy X-ray absorptiometry. The incidence of any cardiovascular diseases in the study patients and the presence of corresponding risk factors were collected and analyzed.

RESULTS

In both elderly Arab females and males, there was an association between total hip and femoral neck BMD and the possibility to have CVD. On the other hand, the results showed that patients who use calcium and vitamin D supplements showed a significant reduction in the incidence of CVD comparing to the non-treated patients.

CONCLUSION

Low total hip and femoral neck BMD were associated with a higher chance to have CVD incidents in both elderly Arab males and females; moreover, calcium and vitamin D supplements have a possible protective role in reducing cardiovascular disease in elderly patients with osteopenia.

Prevalence and Associated Factors of Osteoporosis Among People With Hypertension in Alahsa, Saudi Arabia: A Cross-Sectional Study

Introduction Osteoporosis (OP) and hypertension (HTN) are prevalent conditions impacting elderly health. This study aimed to explore the prevalence and factors associated with OP among people with HTN in Al-Ahsa, Saudi Arabia (2023). Material and method A cross-sectional analytical study was conducted. Adults aged 50-79 diagnosed with HTN were recruited from those referred for dual-energy X-ray absorptiometry (DEXA) scans using a systematic random sampling method. The participants' electronic health records were reviewed and all participants were interviewed using a structured questionnaire to collect data not available in the electronic health records related to demographics, medical history, and lifestyle factors. Chi-square tests and multivariable logistic regression were used to assess the associations between OP and clinical parameters. Results A total of 255 participants were recruited, with 115 (45.1%) having normal bone density, 97 (38%) having osteopenia, and 43 (16.9%) having OP. Females 167 (65.5%) were higher than males 88 (34.5%). The average age of all the respondents was 66.2 ± 7.96 years, and their average body mass index (BMI) was 22.2 ± 15.1. The age in years (mean ± SD) of participants with OP 68.04 ± 7.60 was higher compared to normal 64.9 ± 7.46 (p-value = 0.03). Factors that appear to increase the risk of OP in multivariable logistic regression analysis with an adjusted odds ratio (OR) (95% CI) include increased age (OR: 1.17, CI: 0.9-1.2, p-value = 0.048), and parathyroid gland disorder comorbidity (OR: 15.1, CI: 0.7-32, p-value = 0.03), while some factors that reduce the risk of developing OP include increased BMI (OR: 0.9, CI: 0.91-1.03, p-value = 0.03), literate individuals (OR: 0.1, CI: 0.01-1.4, p-value = 0.046), and taking beta-blockers (BB) treatment (OR: 0.23, CI: 0.01-1.3, p-value = 0.02) reduced odds of developing OP according to results. Conclusion The OP is notably present among people with HTN, especially older people, and parathyroid gland disorders. Higher BMI levels, along with the use of BB, help to decrease it. Additionally, any level of education above illiteracy is associated with a lower prevalence of OP, suggesting that education may have a protective effect against OP in HTN patients. We recommend further research on OP risk factors in HTN Saudi patients. Future research should focus on assessing the impact of educational levels and socioeconomic factors on OP prevalence and investigating the association between specific comorbidities (e.g., diabetes mellitus (DM) and parathyroid gland disorders) and OP risk in HTN individuals. Collaborate with public health authorities and organizations to integrate OP screening into routine HTN patient care protocols.

Association Between Coronary Artery Calcium Score and Bone Mineral Density in Type 2 Diabetes Mellitus with Different Visceral Fat Area

PURPOSE

The relationship between coronary artery calcification and bone mineral density (BMD) in T2DM is still unclear. The aim of this study is to analyze the association between coronary artery calcium score (CACs) and BMD in T2DM with different visceral fat area (VFA), and further to explore the clinical significance of CACs in predicting osteoporosis in T2DM patients.

PATIENTS AND METHODS

A total of 479 T2DM patients aged ≥50 years were included. Agatston was applied to calculate CACs to evaluate the degree of coronary artery calcification. Dual-energy X-ray absorptiometry (DXA) was used to measure BMD. According to VFA, all subjects were divided into VFA <100cm² and VFA ≥100cm² group. Adjusted regression analysis was performed to analyze the association between CACs and BMD. ROC curve was used to analyze the optimal cut-off value of CACs for screening osteoporosis.

RESULTS

The baseline showed that in VFA ≥100cm² group, CACs increased significantly than that in VFA <100cm² group (212.1±195.9 vs 139.3±141.8, p<0.001) and total hip BMD decreased obviously (0.968±0.19 vs 1.021±0.184, p=0.01). After multivariable adjustment, CACs was not significantly associated with BMD in all patients (p>0.05). However, CACs was negatively associated with BMD of total hip and lumbar spine in patients with VFA ≥100cm² (total hip β=-0.087 p=0.01; lumbar spine β=-0.052 p=0.005), but not VFA <100cm². ROC curve analysis showed that the optimal cut-off value of CACs for screening osteoporosis was 191.505.

CONCLUSION

The present study implied that associations between CACs and BMD varied by the visceral fat deposition. It is critical to evaluate the condition of visceral fat accumulation for exploring the complex interplay of coronary artery calcification and BMD in T2DM patients. It may be of some clinical value for CACs in predicting osteoporosis in T2DM with visceral obesity.

Decreased Bone Mineral Density Is a Predictor of Poor Survival in Critically Ill Patients

Alterations in bone mineral density (BMD) have been suggested as independent predictors of survival for several diseases. However, little is known about the role of BMD in the context of critical illness and intensive care medicine. We therefore evaluated the prognostic role of BMD in critically ill patients upon admission to an intensive care unit (ICU). Routine computed tomography (CT) scans of 153 patients were used to assess BMD in the first lumbar vertebra. Results were correlated with clinical data and outcomes. While median BMD was comparable between patients with and without sepsis, BMD was lower in patients with pre-existing arterial hypertension or chronic obstructive pulmonary disease. A low BMD upon ICU admission was significantly associated with impaired short-term ICU survival. Moreover, patients with baseline BMD < 122 HU had significantly impaired overall survival. The prognostic relevance of low BMD was confirmed in uni- and multivariate Cox-regression analyses including several clinicopathological parameters. In the present study, we describe a previously unrecognised association of individual BMD with short- and long-term outcomes in critically ill patients. Due to its easy accessibility in routine CT, BMD provides a novel prognostic tool to guide decision making in critically ill patients.