Femoral neck and spine bone mineral density-Surrogate marker of aortic calcification in postmenopausal women

Value of quantitative ultrasound and bioelectrical impedance analysis in detecting low bone mineral density in hemodialysis

INTRODUCTION

Patients on maintenance hemodialysis (MHD) are highly predisposed to low bone mineral density (BMD). This study aims to assess the value of quantitative ultrasound (QUS), bioelectrical impedance analysis (BIA), and their combination in detecting high-risk patients for low BMD in MHD.

METHODS

Patients' BMD of the total hip, femoral neck, and lumbar spine were measured using dual-energy X-ray absorptiometry (DXA). Bone mineral content (BMC) was assessed using BIA. Calcaneal BMD was measured using QUS. Patients with a T-score of ≤-2.5 were recorded as 'low BMD.'

RESULTS

Overall, 93 subjects (62.37% female; mean age, 60.8 ± 16.2 years) were included in this cross-sectional study; approximately 36.56% met the 'low BMD' criteria. QUS-T score predicted low BMD with an area under the curve (AUC) value of 0.738, sensitivity of 70.59%, and specificity of 76.27%. The AUC for low BMD diagnosis using the BMC index (BMCI) measured through BIA was 0.679 (sensitivity, 91.18%; specificity, 38.98%). On the other hand, the combination of QUS-T score and BMCI yielded a higher AUC value of 0.762 with an improved specificity of 88.14%. Compared with the QUS and BIA alone, the net reclassification improvement (NRI) of the combination model increased by 47.16% (p = 0.022) and 78.36% (p < 0.0001), respectively. Integrated discrimination improvement (IDI) increased by 5.25% (p = 0.043) and 9.99% (p = 0.003), respectively. QUS-T score and BMCI were related to BMD independently assessed by DXA.

CONCLUSION

The combination of QUS and BIA is effective in screening for low BMD among MHD patients.

No Association Between Bone Mineral Density and Breast Arterial Calcification Among Postmenopausal Women

Context

The association between bone mineral density (BMD) and breast arterial calcification (BAC) remains poorly understood and controversial.

Objective

The objective of this article is to examine the association between BMD and BAC in a large cohort of postmenopausal women undergoing routine mammography.

Design

A cross-sectional analysis of baseline data from a multiethnic cohort was performed.

Setting

The setting for this analysis is an integrated health care delivery system in Northern California in the United States.

Patients

A total of 1273 women age 60 to 79 years (mean age, 67 years) were recruited within 12 months of screening mammography.

Main outcome measure

A BAC score (mg) was obtained from digital mammograms using a novel densitometry method. BAC presence was defined as a BAC score greater than 0 mg, and severe BAC as a BAC score greater than 20 mg.

Results

Overall, 53% of women had osteopenia and 21% had osteoporosis. The prevalence of BAC greater than 0 mg was 29%, 30%, and 29% among women with normal BMD, osteopenia, and osteoporosis, respectively (P = 0.98). The prevalence of BAC greater than 20 mg was 5%, 3%, and 5% among women with normal BMD, osteopenia and osteoporosis, respectively (P = .65). The odds ratios (ORs) of BAC greater than 0 mg vs BAC = 0 mg after multivariable adjustment were 1.09 (95% CI, 0.81-1.48; P = .54) for osteopenia and 0.99 (95% CI, 0.69-1.48; P = .98) for osteoporosis. The adjusted ORs for BAC greater than 20 mg vs BAC 20 mg or less were 1.03 (95% CI, 0.52-2.01; P = .93) for osteopenia and 1.89 (95 CI, 0.81-4.47; P = .14) for osteoporosis.

Conclusion

Our findings do not support an association of either osteopenia or osteoporosis with BAC presence or severity among postmenopausal women.

Vessel stiffness, calcification and osteoporosis. Common pathogenetic components

Atherosclerosis and osteoporosis until recently were regarded as the diseases of modern society, and their simultaneous development was explained just by the increased chances with longevity. Currently, there are studies showing evidence on these diseases in ancient populations, regardless the age and gender. The diseases found in younger age, with the early Egyptian civilization, witness on the common genetic and behavioral risk factors and pathogenetic components, than simple age-related chance. Scientific publications show more and more data on common properties of these diseases and pathogenetic mechanisms. High risk of premature death from atherosclerosis and osteoporosis complications facilitates the search for individual and general predictors of the disorders with the aim of on-time prevention. Treatment of atherosclerosis and osteoporosis presentation events in one patient demands for a range of medications that leads to polypragmasia. The review is focused on common mechanisms of vascular stiffness development, calcification and bone density decrease. Profound understanding might make it to open novel targets for one drug to both diseases, with decreased rate of complications.

Bone Strength and Arterial Stiffness Impact on Cardiovascular Mortality in a General Population

Osteoporosis and increased arterial stiffness independently have been found to be associated with higher cardiovascular events rates in the general population (GP). We examined 558 patients from GP by dual-energy X-ray absorptiometry (DXA) and pulse wave velocity (PWV) measurements at baseline, with 36-month follow-up period. DXA assessed bone mineral density of femoral neck (BMD FN) and lumbar spine (BMD LS). Carotid-femoral PWV was assessed by pulsed-Doppler. The aim of our study is to find correlation between bone strength and arterial stiffness and their impact on cardiovascular mortality in GP. The mean ± SD of BMD FN, BMD LS, and PWV was 0.852 ± 0.1432 g/cm(2), 0.934 ± 0.1546 g/cm(2), and 9.209 ± 1.9815 m/s. In multiple regression analysis we found BMD FN (βst = -6.0094, p < 0.0001), hypertension (βst = 1.7340, p < 0.0091), and diabetes (βst = 0.4595, p < 0.0046). With Cox-regression analysis, after 17 cardiovascular events, the significant covariates retained by the backward model were BMD FN (b = -2.4129, p = 0.015) and PWV (b = 0.2606, p = 0.0318). The cut-off values were PWV = 9.4 m/s, BMD FN = 0.783 g/cm(2), and BMD LS = 0.992 g/cm(2). The results for BMD FN and PWV hazard ratio risk were 1.116 and 1.297, respectively. BMD FN as a measure of bone strength and PWV as a measure of arterial stiffness are strong independent predictors of cardiovascular mortality in GP.