Bone mineral density and stroke.
ABSTRACT We sought to assess the long-term predictive usefulness of bone mineral density (BMD) for stroke incidence and stroke mortality.
The First National Health and Nutrition Examination Survey data were obtained from a nationally representative sample of noninstitutionalized civilians. A cohort of 3402 white and black subjects 45 through 74 years of age at baseline (1971 to 1975) was observed through 1992. Hospital records and death certificates were used to identify a total of 416 new stroke cases.
Results were evaluated to determine the relative risk (RR) for stroke per 1-SD decrease in BMD, after controlling for age at baseline, smoking status, alcohol consumption, history of diabetes, history of heart disease, education, body mass index, recreational physical activity, and blood pressure medication. In Cox proportional-hazards analyses, incidence of stroke was not associated with a decrease in BMD in any of the 3 race-sex groups: white men (RR, 1.01; 95% CI, 0.86 to 1.19; P=0.88), white women (RR, 1.13; 95% CI, 0.93 to 1.38; P=0.21), or blacks (RR, 0.93; 95% CI, 0.72 to 1.21; P=0.60). No association between BMD and stroke mortality was found (RR, 1.03; 95% CI, 0.86 to 1.23; P=0.77).
In a large national study, no significant associations of BMD and stroke incidence or mortality were found for whites or blacks.
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ABSTRACT: The association between bone mineral density (BMD) and myocardial infarction (MI) was investigated in 6,872 men and women. For both men and women, lower BMD in the femoral neck and hip was associated with increased risk of MI largely independent of smoking, hypertension, hypertriglyceridemia, and diabetes. The relationship between BMD and cardiovascular disease is not completely understood. The objective of this prospective study was to investigate the risk of MI in relation to bone mineral density and to determine if cardiovascular risk factors could explain this association. Dual energy X-ray absorptiometry was performed in 5,490 women and 1,382 men to determine total hip and femoral neck BMD (in grams per square centimeters) and estimate femoral neck volumetric BMD (in grams per cubic centimeters). During a mean follow-up time of 5.7 years, 117 women and 79 men suffered an initial MI. After adjustment for age and BMI, lower BMD of the femoral neck and total hip was associated with increased risk of MI for both women [hazard ratio (HR) = 1.33, 95% confidence interval (CI) 1.08-1.66 per standard deviation (SD) decrease in femoral neck BMD] and men (HR = 1.74, 95% CI 1.34-2.28 per SD decrease in total hip BMD). After additional adjustment for smoking, hypertension, hypertriglyceridemia, and diabetes, the associations were slightly attenuated in men (HR = 1.42-1.88 in the age and BMI-adjusted model versus 1.33-1.77 in the fully adjusted model) while similar attenuations were seen in women (HR = 1.06-1.25 versus 1.05-1.22). Lower BMD was associated with an increase in MI risk for both men and women. Women had consistently lower HRs compared to men in all models. Adjusting for smoking, hypertension, hypertriglyceridemia, and diabetes did not distinctively weaken these associations.Osteoporosis International 04/2011; 23(3):963-70. · 4.04 Impact Factor
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ABSTRACT: Considerable controversy exists regarding the contribution of mineral/bone metabolism abnormalities to the association between cardiovascular diseases (CVDs) and osteoporotic fractures. To determine the relationships between mineral/bone metabolism biomarkers and CVD in 746 older patients with hip fracture, clinical data were recorded and serum concentrations of parathyroid hormone (PTH), 25-hydroxyvitamin D, calcium, phosphate, magnesium, troponin I, parameters of bone turnover, and renal, liver, and thyroid functions were measured. CVDs were diagnosed in 472 (63.3%) patients. Vitamin D deficiency was similarly prevalent in patients with (78.0%) and without (82.1%) CVD. The CVD group had significantly higher mean PTH concentrations (7.6 vs 6.0 pmol/L, < 0.001), a higher prevalence of secondary hyperparathyroidism (SPTH) (PTH > 6.8 pmol/L, 43.0% vs 23.3%, < 0.001), and excess bone resorption (urinary deoxypyridinoline corrected by creatinine [DPD/Cr] > 7.5 nmol/μmol, 87.9% vs 74.8%, < 0.001). In multivariate regression analysis, SHPT (odds ratio [OR] 2.6, = 0.007) and high DPD/Cr (OR 2.8, = 0.016) were independent indictors of CVD. Compared to those with both PTH and DPD/Cr in the normal range, multivariate-adjusted ORs for the presence of CVD were 17.3 ( = 0.004) in subjects with SHPT and 9.7 ( < 0.001) in patients with high DPD/Cr. CVD was an independent predicator of SHPT (OR 2.8, = 0.007) and excess DPD/Cr (OR 2.5, = 0.031). CVD was predictive of postoperative myocardial injury, while SHPT was also an independent predictor of prolonged hospital stay and in-hospital death. SHPT and excess bone resorption are independent pathophysiological mediators underlying the bidirectional associations between CVD and hip fracture, and therefore are important diagnostic and therapeutic targets.Clinical Interventions in Aging 01/2013; 8:239-56. · 2.65 Impact Factor
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ABSTRACT: BACKGROUND: Low bone mineral density (BMD) has been associated with increased mortality in prospective cohort studies of the elderly, but the real relationship is still controversial. We undertook a meta-analysis to evaluate the association of BMD with risk of all-cause, cardiovascular and stroke mortality. METHODS: We performed systematic searches on MEDLINE, EMBASE, OVID, CINAHL, and the Cochrane Library. Data extraction was performed independently by two reviewers. For each study, hazard ratios (HRs) and 95% confidence intervals (CI) per standard deviation (SD) decrease in BMD were extracted. Heterogeneity, publication bias, subgroup, and meta-regression analysis were performed. RESULTS: The analysis included 46,182 participants from 10 studies with 3991 all-cause deaths, 1479 cardiovascular deaths and 403 stroke deaths during a median of 7years follow-up (range 2.8-18.7years). Lower BMD had a significant inverse relationship with all-cause and cardiovascular mortality, a per SD decrease in BMD at all sites being associated with a 1.17-fold (95% CI: 1.13-1.22) increase in total mortality and a 1.13-fold increase in cardiovascular mortality (95% CI: 1.06-1.20). Lower total hip/femoral neck BMD was also related to all-cause mortality (HR 1.20; 95% CI: 1.09-1.31) and cardiovascular mortality (HR 1.20; 95% CI: 1.04-1.35). BMD was not associated with the risk of stroke mortality (HR 1.08, 95% CI; 0.89-1.28). CONCLUSIONS: Lower BMD is associated with significantly increased risk of all-cause and cardiovascular mortality. There is no significant association between lower BMD and the risk of stroke mortality. The relationship between lower BMD and individual mortality should be investigated further in randomized trials.International journal of cardiology 11/2011; · 7.08 Impact Factor