Article

Reduced Bone Mineral Density Is Associated with Breast Arterial Calcification

January 2008
The Journal of Clinical Endocrinology and Metabolism 93(1):208-11

DOI:10.1210/jc.2007-0693

Source
PubMed

Authors:

Columbia University

Arterial calcification, a marker of atherosclerosis, results from a complex process of biomineralization resembling bone formation. Breast arterial calcification (BAC) has been associated with angiographic and clinical cardiovascular disease. The purpose of this study was to determine the association between reduced bone mineral density (BMD) and BAC, which may share a common pathophysiology. We conducted a retrospective study of 228 women (55% Hispanic, mean age 64 +/-10 yr) who had both mammography and BMD evaluation at Columbia University Medical Center from 2001-2003. Each mammogram was reviewed for the presence of BAC using standardized methods. BMD was measured using dual-energy x-ray absorptiometry and categorized as normal, low bone density (osteopenia), or osteoporosis as defined by the World Health Organization. Univariate and multivariate logistic regression analyses were performed to evaluate the association between reduced BMD and BAC. The prevalence of BAC, low bone density (osteopenia), and osteoporosis was 39, 42, and 29%, respectively. Women with BAC were significantly more likely to be older, Hispanic, and postmenopausal and have osteoporosis as compared with women without BAC. In age-adjusted analyses, women with BAC were more likely to have reduced BMD (odds ratio 3.0, P < 0.01) as compared with women without BAC. Furthermore, osteoporosis was strongly associated with the presence of BAC (odds ratio 3.5, P < 0.01). These data suggest that osteoporosis and arterial calcification are strongly and independently correlated. Reduced BMD may identify women at risk of vascular disease.

Breast artery calcification and osteoporosis in postmenopausal woman: A case report and opinion on the problem

Article

Sep 2020

Mammography is one of the most common screening test in the female population. In addition to identifying breast cancer, vascular calcification is clearly visualized on the mammogram, which is associated with an increased risk of cardiovascular disease, atherosclerosis, and a number of other chronic non-communicable diseases. The article presents a case report of a postmenopausal woman with breast artery calcification and osteoporosis. Identification of women at risk of non-cancer diseases significantly expands the prospects of using mammography for screening.

Mammographic Screening as a Tool for Cardiovascular Risk Assessing. Part 1. Breast Arterial Calcification: Pathomorphology, Prevalence and Risk Factors

Article

Full-text available

May 2019

Breast arterial calcification (BAC) is a type of calcification of the media of the middle and small arteries (Menkeberg's calcification). This distinguishes it from calcification associated with the atherosclerotic process and localized in the intima of the vessel. There are data on the association of BAC with cardiovascular diseases (CVD). This allows it to be considered as a new marker of cardiovascular risk in women. The purpose of the first part of the review is to analyze the current literature on the prevalence of BAC, factors related to its occurrence and the association of BAC with traditional CVD risk factors. The prevalence of BAC (data from cancer screening programs) is about 12.7%, and it increases with age to 50% in 80-year-old women. It is not an attribute of "healthy aging", but depends on race and ethnicity. There is a connection with reproductive function. The frequency of BAC increases with the number of children born, with breastfeeding, in menopause, and decreases during hormone replacement therapy. Smoking women have a BAC frequency 2 times less than non-smokers. Detection of BAC on mammograms is associated with conditions pathogenetically associated with CVD: an increase in the frequency of hyperlipidemia, diabetes, chronic kidney disease, a decrease in bone mass. There is a strong correlation of BAC with coronary calcium (indicator of coronary atherosclerosis). A statistically significant association of BAC with overweight, obesity, and smoking was not found, but there is a weak association with arterial hypertension. This may indicate an independent pathophysiological role of BAC in the development of vascular disorders and allows us to consider BAC as an independent marker for improving cardiovascular risk stratification in women. BAC is believed to be a marker of a more generalized trend towards the development of medial calcification in other vascular areas. This leads to a systemic increase in arterial stiffness and contributes to the development of CVD. © 2019 Stolichnaya Izdatelskaya Kompaniya. All rights reserved.

Bone Density in Postmenopausal Women with or without Breast Arterial Calcification

Article

Full-text available

Mar 2017

Background Identification of osteoporosis in women in order to prevent its related morbidity and mortality is considered a priority. Routine mammography is performed on all menopausal women as a screening tool. Determination of the relation between breast arterial calcification (BAC) on mammography and the bone density of this high-risk population could help us to determine those with osteoporosis. The aim of this study was to investigate the mentioned probable relation between BAC and osteoporosis. Materials and Methods In this cross-sectional study, menopausal women referred for annual screening mammography were enrolled. According to the results of mammography, they were classified into two groups: menopausal women with and without calcification of breast arteries. The selected women were referred for bone mineral density (BMD) evaluation by dual-energy x-ray absorptiometry (DXA). The results of BMD were compared between the two studied groups. Results In this study, BMD was measured in 43 and 45 menopausal women with and without BAC, respectively. After age adjustment the difference between BMD measurements were not statistically significantly different (P > 0.05). There was a significant negative correlation between age and lumbar (P = 0.002, r = -0.42) and hip bone (P = 0.000, r = -0.67) density in menopausal women with BAC. Conclusion The results of the current study indicated that there was no significant relationship between BAC and BMD in our studied population, but it seems that increasing age has an important role in both developing BAC and reducing BMD. For obtaining more conclusive results, further studies with larger sample sizes and considering the severity of BAC is recommended.

Decreased Bone Mineral Density Is an Independent Predictor for the Development of Atherosclerosis: A Systematic Review and Meta-Analysis

Article

Full-text available

May 2016
PLOS ONE

Background: There is conflicting evidence regarding the association between decreased bone mineral density (BMD) and atherosclerosis. To this end, we performed a systematic review and meta-analysis to clarify the association. Methods: To identify relevant studies, PubMed, Embase, and the Cochrane Library were systematically searched up to November 2015. All observational and comparative studies directly investigating the relationship between decreased BMD and clinical consequences of atherosclerotic vascular abnormalities, including carotid artery calcification (CAC), cardiovascular disease (CAD), and coronary artery disease (CAD) were obtained, without limitation of language or publication year. Results: A total of 25 studies involving 10,299 patients were included. The incidence of atherosclerotic vascular abnormalities was significantly increased in low BMD patients, compared to patients with normal BMD (OR, 1.81, 95% CI [1.01, 2.19], p<0.00001)). Similar results were also observed for postmenopausal women (OR, 2.23, 95% CI [1.72, 2.89], p<0.00001). Subgroup analyses of osteopenia, osteoporosis, and normal BMD also revealed that the combined ORs for the incidence of atherosclerotic vascular abnormalities increased as BMD decreased. Of note, after adjusting for age, sex, body mass index (BMI) and other vascular risk factors, decreased BMD remained significantly associated with the incidence of atherosclerotic vascular abnormalities (OR, 2.96, 95% CI [2.25, 3.88], p < 0.00001). Conclusions: Based on the results of this study, decreased BMD is an independent predictor for the development of atherosclerosis in elderly individuals. Moreover, the risk of atherosclerotic vascular abnormalities increased as BMD decreased. Future studies focusing on individuals with different severities of atherosclerosis and comorbidities are of interest.

Association of breast arterial calcification andosteoporosis in Turkish women

Article

Full-text available

Jan 2015
PAK J MED SCI

Breast arterial calcification (BAC), medial calcific sclerosis of small to medium-sized muscular arteries, is a benign finding of mammographic evaluation. Previous studies have shown the relationships between BAC and systemic disorders such as cardiovascular disease, diabetes mellitus and hypertension. The aim of this study was to determine the association between reduced bone mineral density and BAC. The study population consisted of 567 women who had both mammography and bone mineral density evaluation. BAC (+) and BAC (-) women were compared for age, body mass index, postmenopausal duration, number of deliveries, breastfeeding duration, DM, HT, lipid treatment, osteopenia, and osteoporosis. BAC was seen in mammographic evaluation of 179 women and 388 subjects without BAC accepted as the control group. There was a statistically significant relationship between age, postmenopausal duration, number of deliveries, history of DM, HT, lipid treatment and BAC. While the prevalence of osteopenia was higher in control group (52.8%), the rate of osteoporosis (48.7%) was higher in group with BAC. There was statistically significant relationship between BAC and osteoporosis in postmenopausal women. Determination of BAC in routine screening mammography might be helpful in both identifying women with risk of cardiovascular disease and osteoporosis.

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

Article

Full-text available

Nov 2019

Context The association of bone mineral density (BMD) and breast arterial calcification (BAC) remains poorly understood and controversial. Objective To examine the association between BMD and BAC in a large cohort of post-menopausal women undergoing routine mammography. Design Cross-sectional analysis of baseline data from a multiethnic cohort. Setting Integrated health care delivery system in Northern California, USA. Patients 1,273 women aged 60 to 79 years (mean age 67), all 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 > 0 mg, and severe BAC as a BAC score > 20 mg. Results Overall, 53% of women had osteopenia and 21% had osteoporosis. The prevalence of BAC > 0 mg was 29%, 30% and 29% among women with normal BMD, osteopenia and osteoporosis, respectively (p=0.98). The prevalence of BAC > 20 mg was 5%, 3% and 5% among women with normal BMD, osteopenia and osteoporosis, respectively (p=0.65). The odds ratios (ORs) of BAC > 0 vs. BAC=0 mg after multivariable adjustment were 1.09 (95% CI, 0.81-1.48; p=0.54) for osteopenia and 0.99 (95% CI, 0.69-1.48; p=0.98) for osteoporosis. The adjusted OR for BAC > 20 vs BAC ≤20 mg were 1.03 (95%CI, 0.52-2.01; p=0.93) for osteopenia and 1.89 (95 CI, 0.81-4.47; p=0.14) for osteoporosis. Conclusion Our findings do not support an association of either osteopenia or osteoporosis with BAC presence or severity among postmenopausal women .

Relationship of Elongated Styloid Process in Digital Panoramic Radiography with Carotid Intima Thickness and Carotid Atheroma in Doppler Ultrasonography in Osteoporotic Females

Article

Full-text available

Jun 2015

Cardiovascular disease and osteoporosis are major health dilemmas. Osteoporotic patients frequently display vascular calcification that consequently increases the cardiovascular morbidity and mortality. This study aimed to investigate the relation of osteoporosis, vascular calcification (atheroma, intima-media thickness (IMT)) and elongated styloid process (ESP) in a sample of osteoporotic and normal female individuals. This study recruited 78 women who were assessed for bone mass density (BMD). Sample included individuals with normal BMD (n=13, 17 %), osteopenia (n=36, 46 %), and osteoporosis (n=29, 37%). The presence of atheroma and IMT was examined using color Doppler ultrasonography (CD-US). In addition, digital panoramic radiographs (PRs) were obtained to assess ESP. In this study, 55 subjects (70%) with low BMD exhibited at least one side ESP. Femoral BMD decreased significantly in subjects with ESP (p= 0.03). Bilateral ESP was correlated with the presence of atheroma (p= 0.029). The CIMT was greater in patients with ESP, although the relation was not significant. The obtained data suggest referring the aged individuals with ESP for BMD assessment and individuals with low bone mass and ESP for more cardiovascular risk assessment.

EVALUACIÓN DE OSTEOPOROSIS Y ATEROESCLEROSIS CAROTÍDEA EN RELACIÓN A ENFERMEDAD CEREBROVASCULAR OCLUSIVA

Article

Full-text available

Dec 2009

Objective. To determine the association between carotid atherosclerotic manifestations and osteoporosis in patients with occlusive cerebrovascular disease (OCVD). Method. From June 2007 to June 2009 115 patients with clinical tomographic diagnosis of ECVO, who underwent carotid artery-Color Doppler Ultrasound exams as well as lumbar spine and hip bone densitometry, were studied. Results. No correlation between the value of bone mineral density (BMD) and the magnitude of carotid atherosclerotic damage was observed. There was a moderate positive correlation between Body Mass Index (BMI) and BMD. Most risk factors were associated with increased intima media thickness, increased atherogenic index, low rates of significant stenosis, and densitometric osteopenia, with aging and hypertension as predominant factors. Conclusions. Despite the presence of shared risk factors, no correlation between osteoporosis and atherosclerotic manifestations in the carotid artery in OCVD was observed.

The Influence of Osteoporosis in Oral Health

Chapter

Full-text available

Mar 2012

Elderly patients have decreased bone regenerative capabilities. Osteoporosis, characterized by the reduction in the bone mineral density and microarchitectural deterioration, is more frequent in elderly rather than in younger patients. Bone mineral density can be measured using different radiographic techniques, such as panoramic radiography and dual-energy x-ray absorptiometry. Panoramic radiography is a common exam in oral practice and allows practitioners to routinely analyze the components of the stomatognathic system. According to literature, the amount of mandibular bone mass is directly related with skeletal bone mass. Osteoporosis, though not being the primary cause or the initial factor for periodontitis, has been shown to be a risk indicator that may contribute to the progression of periodontal disease, for being an indicative for the reduction of crestal bone levels. However, the evaluation of the relationship between osteoporosis and periodontitis is complex. Multiple systemic factors influence the progression of osteoporosis, including age, race, diet, gender, hormone therapy, smoking, genetic factors, exercise, and body weight. Several of these factors are also risk factors for severe periodontal disease. Local factors, such as bacterial plaque and calculus, may also disguise the effect of osteoporosis in the periodontal status. The consequences of systemic bone loss in the success of dental implants are poorly understood. The diagnosis of low bone mineral density is therefore necessary before implant rehabilitation because of the increased bone fragility and susceptibility to fracture. Low bone mineral density may also compromise the primary stability of oral implants. This review of the literature aims to investigate current diagnosis techniques of low bone mineral density available to the oral practitioner. The relationship between osteoporosis and periodontitis, tooth loss and the risk factors for implant placement in osteoporotic patients will also be reviewed.

OSTEOPOROSIS RISK IN WOMEN WITH BREAST VASCULAR CALCIFICATIONS REVEALED AT MAMMOGRAPHY

Article

Full-text available

Dec 2024

Introduction. Calcium salt deposits in the breast vessel walls can share the mutual mechanisms compared to the ones of bone tissue mineralization mediated by the osteoprotegerin or receptors of the protein glycation end products. Aim: To assess the risk of osteoporosis or other mineral turnover disturbances in women with breast vascular calcifications found on mammography. Materials and Methods. Our study included 189 female patients who underwent mammography in 2018 and then were followed up to the year 2023. They were divided into the three groups: No calcifications group, moderate (grade 1-2) calcifications group, and pronounced (grade 3-4) calcifications group. All the patients underwent screening mammography, the dual-energy X-ray absorptiometry, and serum biochemistry tests (25-hydroxyvitamin D, total and ionized calcium, phosphorus, and magnesium). Results and Discussion. In 2018, 57 (30.16%) patients had breast vascular calcifications. The increased calcification degree was associated with the age. The most significant changes were found in TBS T-score values: In the moderate calcifications group, it was 27.5% lower compared to the no calcifications group (p=0.042); while in the pronounced calcifications group, it was 41.7% lower compared to the no calcifications group (p=0.007). Conclusions. Breast vascular calcifications are associated with the significant drop of TBS T-score values (from -2.31 to -3.97; р=0.008).

Role and progress of artificial intelligence in radiodiagnosing vascular calcification: a narrative review

Article

Full-text available

Jan 2023

Background and objective: Vascular calcification has important clinical significance due to its vital prognostic value for cardiovascular diseases, chronic kidney disease (CKD), diabetes, fracture, and other multisystem diseases. Radiology is the main diagnostic method of it, but facing great pressure such as the increasing workload and decreasing working accuracy rate. Therefore, radiology needs to find a way out to better realize the clinical value of vascular calcification. Artificial intelligence (AI) encompasses any algorithm imitating human intelligence. AI has shown great potential in image analysis, such as its high speed and accuracy, becoming the savior of the current situation. In order to promote more rational utilization, the role and progress of AI in this field were reviewed. Methods: A search was conducted in PubMed and Web of Science. The key words included "artificial intelligence", "machine learning", "deep learning", and "vascular calcification". The qualitative analysis of literature was achieved through repeated deliberation after refining valuable content. The theme is the role and progress of AI in the diagnostic radiology of vascular calcification. Key content and findings: Sixty-two articles were included. AI has been applied to the diagnostic radiology of 5 types of vascular calcification, including coronary artery calcification (CAC), thoracic aortic calcification (TAC), abdominal aortic calcification (AAC), carotid artery calcification, and breast artery calcification (BAC). Deep learning (DL), the latest technology in this field has been well applied and satisfactorily performed. Radiologists have been able to achieve efficient diagnosis of 5 types of vascular calcification through AI, with reliable accuracy. Conclusions: Increasingly, advanced AI has achieved an accuracy comparable to that of human experts, with a faster speed. Moreover, the ability to reduce noise and artifacts enables more imaging equipment to obtain reliable quantification. AI has acquired the ability to cooperate with radiology departments in future work. However, the research in AAC and carotid artery calcification can be more in-depth, and more types of vascular calcification and more fields of radiology should be expanded to. The interpretation of results made by AI and the promotion of existing achievements to the development of other disciplines are also the focus in future.

2022 Prevention of chronic non-communicable diseases in Of the Russian Federation. National guidelines

Article

Full-text available

Apr 2022

Brain damage in sleep-disordered breathing: the role of glia

Article

Jan 2022
ZH NEVROL PSIKHIATR

Sleep-disordered breathing (SDB) is one of the most prevalent sleep-wake disorders and is associated with brain damage. In this review, we describe the role of astroglia, microglia and oligodendroglia as the main cellular mediators of brain damage in SDB based on the results of experimental studies. Specifically, we describe the role of the molecules that are expressed by glia and mediate oxidative stress (NADPH-oxidase), inflammation (hypoxia-inducible factor-1, inducible nitric oxide synthase, pro- and anti-inflammatory cytokines) and sympathetic hyperactivation (ATP, lactate).

Reproductive factors and breast arterial calcification: a systematic review and meta-analysis

Article

Oct 2021
CLIMACTERIC

Background: Breast arterial calcification (BAC) is a common incidental finding on screening mammography. Recent evidence suggests that BAC is associated with cardiovascular disease (CVD). We systematically reviewed the associations between BAC and reproductive factors (menopausal status, hormone replacement therapy [HRT] use, oral contraceptive [OC] use and parity). Methods: MEDLINE and EMBASE databases, references of relevant papers and Web of Science were searched up to February 2020 for English-language studies that evaluated these associations. Study quality were determined and a random effects model was used to assess these associations. Results: Nineteen observational studies (n = 47,249; three cohort studies, seven case-control studies, nine cross-sectional studies) were included. BAC was associated with menopause (nine studies; n = 15,870; odds ratio [OR] 2.67; 95% confidence interval [CI] 1.50-4.77) and parity (seven studies; n = 27,728; OR 2.50; 95% CI 1.68-3.71) and inversely with HRT use (10 studies; n = 33,156; OR 0.57; 95% CI 0.40-0.80). No association was found with OC use. Eleven studies were considered good in quality. Marked heterogeneity existed across all analyses. Conclusions: BAC is associated with HRT use, menopause and parity. However, careful interpretation is required as marked heterogeneity existed across all analyses. Traditional cardiovascular risk factors may need to be taken into account in future investigations of associations between BAC and reproductive factors. Prospero: CRD42020141644.

The Present View of the Correlation of Breast Vascular Calcifications with Coronary Artery Calcifications

Article

Full-text available

Jun 2021

Breast vascular calcifications are a manifestation of calcinosis of the medial layer of the artery walls. This type of calcifications is well visualized on mammograms. Mammography is a widespread and affordable screening test for breast cancer. The studies published in recent years demonstrate a relationship of breast vascular calcifications to cardiovascular risk factors, coronary heart disease. Identification of the correlation of breast vascular calcifications with coronary artery calcifications will be able to improve cardiovascular risk stratification in the group of women with an asymptomatic course.

Breast Arterial Calcification: A Potential Biomarker for Atherosclerotic Cardiovascular Disease Risk?

Article

Full-text available

May 2021
Curr Atherosclerosis Rep

Purpose of Review We aimed to summarize the current evidence regarding the association between breast arterial calcification (BAC) and atherosclerotic cardiovascular disease (ASCVD) in women and discuss the potential role of BAC in the risk stratification and preventive approaches for ASCVD. Recent Findings BAC has emerged as a potential women-specific risk marker for ASCVD. Although BAC presents as a medial calcification of the arteries, notably different from the intimal atherosclerotic process, current evidence supports a correlation between BAC and ASCVD risk factors or subclinical and clinical ASCVD, such as coronary artery disease or stroke. As millions of women undergo mammograms each year, the potential clinical application of BAC in enhanced ASCVD risk estimation, with no additional cost or radiation, has tremendous appeal. Summary Although further research regarding optimal risk assessment and management in women with BAC is required, the presence of BAC should prompt healthy cardiovascular lifestyle modifications.

Breast arterial calcification on mammography and risk of coronary artery disease: a SCOT-HEART sub-study

Article

Full-text available

Feb 2019
CLIN RADIOL

Aim: To assess the prevalence of breast arterial calcification (BAC) in patients who also underwent routine surveillance mammography, and to determine the association with cardiovascular risk factors, coronary artery calcification, and coronary artery disease on coronary computed tomography angiography (CCTA). Materials and methods: Four hundred and five female participants were identified who had undergone CCTA and subsequent mammography in the SCOT-HEART randomised controlled trial of CCTA in patients with suspected stable angina. Mammograms were assessed visually for the presence and severity of BAC. Results: BAC was identified in 93 (23%) patients. Patients with BAC were slightly older (63±7 versus 59±8 years, p<0.001), with a higher cardiovascular risk score (19±11 versus 16±10, p=0.022) and were more likely to be non-smokers (73% versus 49%, p<0.001). In patients with BAC, coronary artery calcification was present in 58 patients (62%; relative risk [RR] 1.26, 95% confidence intervals [CI]: 1.04, 1.53; p=0.02), non-obstructive coronary artery disease in 58 (62%; RR 1.27, 95% CI: 1.04 to 1.54, p=0.02), and obstructive coronary artery disease in 19 (20%; RR 1.62, 95% CI: 0.98, 2.66; p=0.058). Patients without BAC were very unlikely to have severe coronary artery calcification (negative predictive value 95%) but the diagnostic accuracy of BAC to identify coronary artery disease was poor (AUC 0.547). Conclusion: Although BAC is associated with the presence and severity of coronary artery calcification, the diagnostic accuracy to identify patients with coronary artery disease or obstructive coronary artery disease is poor.

Osteoporosis is inversely associated with arterial stiffness in the elderly: An investigation using the Osteoporosis Self-assessment Tool for Asians index in an elderly Chinese cohort

Article

Full-text available

Feb 2019
J Clin Hypertens

Although the association of arterial stiffness and osteoporosis has been reported, the relation of arterial stiffness with risk of osteoporosis and bone fracture is not established. The authors investigated the correlation between arterial stiffness (brachial‐ankle pulse wave velocity [baPWV]), including a cutoff value, and risk of osteoporosis as assessed by the Osteoporosis Self‐assessment Tool for Asia (OSTA) index in 129 elderly Chinese community‐dwelling individuals (age 83.2 ± 12.8 years, 63 females). OSTA was negatively correlated with baPWV (r = −0.326, P = 0.023) after adjusting for confounding factors such as gender, body mass index, low‐density lipoprotein, triglycerides, estimated glomerular filtration rate, absence or presence of diabetes, absence or presence of hypertension, and uric acid. baPWV was an independent factor for changes in OSTA (β = −0.001, P = 0.002). ROC curve analysis confirmed association between baPWV and OSTA index (AUC = 0.742 [CI: 0.660, 0.824]; P < 0.001) with a baPWV cutoff value of 1676 cm/s (sensitivity, 80.7%; specificity, 60%) for prediction of high OSTA index. The study showed a significant correlation between OSTA index and baPWV, suggesting a potential predictive value of baPWV in elderly patient at high risk of osteoporosis.

Relación de la aterosclerosis carotídea con la osteoporosis de columna lumbar y caderas en el infarto agudo de miocardio

Article

Full-text available

Mar 2014

Objective: determine the relationship between carotid atherosclerosis and lumbar spine and hip osteoporosis in patients with acute myocardial infarction. Methods: a study was conducted of 104 patients with a clinical and laboratory diagnosis of acute myocardial infarction. All patients underwent carotid Doppler ultrasonography for intima media thickness, location and type of atheromatous plaques, stenosis degree and atherogenic index, followed by lumbar spine and hip densitometry. Bone mineral density levels were classified as normal, osteopenia or osteoporosis, according to the T-score. Results: no correlation was found between bone mineral density values and the extent of atherosclerotic damage to the carotid sector. Most risk factors were associated with normal intima media thickness values, an increased atherogenic index, a low prevalence of significant stenosis, and densitometric osteopenia. Aging and hypertension were the predominant risk factors. Conclusions: except for the existence of common risk factors, no association was found between osteoporosis and carotid atherosclerosis in patients with acute myocardial infarction.

Detecting Cardiovascular Disease from Mammograms With Deep Learning

Article

Jan 2017

Coronary artery disease is a major cause of death in women. Breast arterial calcifications (BACs), detected in mammograms, can be useful risk markers associated with the disease. We investigate the feasibility of automated and accurate detection of BACs in mammograms for risk assessment of coronary artery disease. We develop a twelve-layer convolutional neural network to discriminate BAC from non-BAC and apply a pixelwise, patch-based procedure for BAC detection. To assess the performance of the system, we conduct a reader study to provide ground-truth information using the consensus of human expert radiologists. We evaluate the performance using a set of 840 full-field digital mammograms from 210 cases, using both freeresponse receiver operating characteristic (FROC) analysis and calcium mass quantification analysis. The FROC analysis shows that the deep learning approach achieves a level of detection similar to the human experts. The calcium mass quantification analysis shows that the inferred calcium mass is close to the ground truth, with a linear regression between them yielding a coefficient of determination of 96.24%. Taken together, these results suggest that deep learning can be used effectively to develop an automated system for BAC detection in mammograms to help identify and assess patients with cardiovascular risks.

Reducing false positives of microcalcification detection systems by removal of breast arterial calcifications

Article

Apr 2016

Purpose: In the past decades, computer-aided detection(CADe)systems have been developed to aid screening radiologists in the detection of malignant microcalcifications. These systems are useful to avoid perceptual oversights and can increase the radiologists’ detection rate. However, due to the high number of false positives marked by these CADesystems, they are not yet suitable as an independent reader. Breast arterial calcifications (BACs) are one of the most frequent false positives marked by CADesystems. In this study, a method is proposed for the elimination of BACs as positive findings. Removal of these false positives will increase the performance of the CADesystem in finding malignant microcalcifications.

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Data

Full-text available

Dec 2015

Type 2 diabetes alters bone and marrow blood flow and vascular control mechanisms in the ZDF rat

Article

Full-text available

Apr 2015
J ENDOCRINOL

Bone health and cardiovascular function are compromised in individuals with type 2 diabetes mellitus (T2DM). The purpose of this study was to determine whether skeletal vascular control mechanisms are altered during the progression of T2DM in Zucker diabetic fatty (ZDF) rats. Responses of the principal nutrient artery (PNA) of the femur from obese ZDF rats with prediabetes, short-term diabetes, and long-term diabetes to endothelium-dependent (acetylcholine) and -independent (sodium nitroprusside) vasodilation and potassium chloride, norepinephrine (NE), and a myogenic vasoconstrictor were determined in vitro. Few changes in the PNA vasomotor responses occurred for the prediabetic and short-term diabetic conditions. Endothelium-dependent and -independent vasodilation were reduced, and NE and myogenic vasoconstriction were increased in obese ZDF rats with long-term diabetes relative to lean age-matched controls. Differences in endothelium-dependent vasodilation of the femoral PNA between ZDF rats and controls were abolished by the nitric oxide synthase inhibitor N(G)-nitro-l-arginine methyl ester. The passive pressure-diameter response of the femoral PNA was also lower across a range of intraluminal pressures with long-term T2DM. Regional bone and marrow perfusion and vascular conductance, measured in vivo using radiolabeled microspheres, were lower in obese ZDF rats with long-term diabetes. These findings indicate that the profound impairment of the bone circulation may contribute to the osteopenia found to occur in long bones during chronic T2DM. © 2015 Society for Endocrinology.

Association of breast arterial calcification with stroke and angiographically proven coronary artery disease: A meta-analysis

Article

Full-text available

Jul 2014

Objective: We conducted a meta-analysis of the current literature to deduce the strength of association between breast arterial calcification (BAC) and coronary artery disease (CAD) and/or stroke. Methods: PubMed, Google Scholar, ClinicalTrials.gov, and Ovid were searched for English-language literature up to August 2013 using the terms "breast arterial calcification," "breast vascular calcification," "coronary artery disease," "coronary heart disease," "cardiovascular disease," "abnormal coronary angiography," and "stroke." A hand search of the reference lists of key articles was performed to supplement the literature search. Our literature search revealed 75 articles for further abstract review. Limiting our search to articles that quantitatively assessed the correlation between BAC and stroke or angiographically proven CAD, we reviewed 35 full manuscripts. Of these articles, 14 were included in the final analysis. Results: We analyzed 10 cross-sectional studies (n = 3,952) with CAD as the primary outcome (diagnosed by coronary angiography). The odds ratio (95% CI) for CAD in those with BAC versus those without BAC is 3.86 (3.25-4.59) (P < 0.0001). For stroke, six cross-sectional studies were analyzed (n = 18,888). The odds ratio (95% CI) for stroke in those with BAC versus those without BAC is 1.54 (1.25-1.90) (P < 0.0001). Conclusions: These results suggest that BAC is significantly associated with both CAD and stroke. Although more prospective studies are warranted to clarify whether BAC is truly a predictor of the future development of CAD and stroke, the concept that BAC is a benign finding is waning.

Breast Arterial Calcification: A New Marker of Cardiovascular Risk?

Article

Full-text available

Apr 2013

Mammographically-detected breast arterial calcifications (BAC) are considered to be an incidental finding without clinical importance since they are not associated with increased risk of breast cancer. The goal of this article is to review existing evidence that the presence of BAC on mammography correlates with several (but not all) traditional cardiovascular disease (CVD) risk factors and with prevalent and incident CVD. Thus, BAC detected during routine mammography is a noteworthy finding that could be valuable in identifying asymptomatic women at increased future CVD risk that may be candidates for more aggressive management. In addition, there are notable differences in measures of subclinical atherosclerosis burden in women (ie, coronary artery calcification) by race/ethnic background, and the same appears to be true for BAC, although data are very limited. Another noteworthy limitation of prior research on BAC is the reliance on absence vs presence of BAC; no study to date has determined gradation of BAC. Further research is thus required to elucidate the role of BAC gradation in the prediction of CVD outcomes and to determine whether adding BAC gradation to prediction models based on traditional risk factors improves classification of CVD risk.

Factors Associated with Breast Arterial Calcification on Mammography

Article

Full-text available

Mar 2013
JCPSP-J COLL PHYSICI

Objective: To determine the frequency of breast arterial calcifications (BAC) as seen on mammographic examination and to determine the association between BAC and hypertension, age, parity and weight of the person. Study design: Cross-sectional analytic study. Place and duration of study: Department of Diagnostic Radiology, Military Hospital, Rawalpindi, from January 2006 to January 2007. Methodology: Two hundred patients undergoing mammography were studied to evaluate the association of BAC with raised blood pressure, age and parity. Previous history of lactation and the patients' weight were also recorded. Proportions of classes were compared using chi-square test. Results: 13.5% of the subjects (n = 200) were positive for BAC on mammograms. Mean age of the BAC positive subjects was higher than their counterparts found negative for BAC. Women bearing 5 - 6 children showed the highest frequency of BAC. Seventy seven (10.38%) of the BAC positive cases had previous history of lactation, whereas 15.44% (n = 123) had not breast fed their children and showed BAC. No significant association of presence of BAC was noted with the weight of the subjects. Conclusion: The frequency of presence of BAC on mammography was associated with systemic hypertension and higher age. It also increased with the reproductive parameters of a woman.

Bone Mineral Density as a Predictor of Atherosclerosis and Arterial Wall Stiffness in Obese African-American Women

Article

Dec 2012

Bone demineralization is associated with higher cardiovascular event rates, possibly due to vascular calcification and accelerated atherosclerosis. African-Americans have less bone loss and less calcium content within atherosclerotic plaques. However, whether loss of bone mass is related to atherosclerosis has not been examined in African-Americans. The objective of this study was to evaluate possible associations between bone mineral density (BMD), carotid intimal-medial thickness (CIMT), and arterial stiffness. We studied 100 obese African-American women (BMI: 26.6 ± 6.2; age: 63 ± 14 years) referred for BMD estimation by dual-energy X-ray absorptiometry scan. BMD (g/cm(2)) was obtained at the lumbar spine (L1-L4), femoral neck, and total hip. Arterial stiffness was evaluated by the heart rate-corrected augmentation index (AI@75) and pulse wave velocity (PWV) using applanation tonometry. CIMT was measured by vascular ultrasound. Mean CIMT, AI@75, and PWV were 0.72 ± 0.14 mm, 28.8 ± 9.0%, and 8.9 ± 1.6 m/s, respectively. Mean BMD values at the lumbar spine, femoral neck, and hip were 0.96 ± 0.19, 0.80 ± 0.16, and 0.91 ± 0.17 g/cm(2). Older subjects had higher CIMT (r = 0.61, p < 0.001) and AI@75 (r = 0.42, p < 0.001). There was a significant correlation between AI@75 and CIMT (r = 0.45, p < 0.001). BMD was negatively correlated with AI@75 (lumbar: r = -0.22, p = 0.03; femoral neck: r = -0.24, p = 0.01; hip: r = -0.21, p = 0.03). BMD was unrelated to CIMT (lumbar: r = -0.09, p = 0.42; femoral neck: r = -0.15, p = 0.17; hip: r = -0.13, p = 0.23). On multivariate analysis, age (p < 0.001), hypertension (p = 0.02), and lumbar BMD (p = 0.01, R(2) = 0.30) were independent predictors of increased AI@75 after adjusting for age, height, and cardiovascular risk factors. These findings were unchanged upon substitution of femoral neck BMD (p = 0.05, R(2) = 0.28) into the model. There was a trend with hip BMD (p = 0.06, R(2) = 0.28) in the regression model. Age-matched comparison between normal BMD (n = 25) and osteoporotic patients (n = 34) demonstrated a significant difference in AI@75 (26.6 ± 8.9 vs. 31.6 ± 9.1%, p = 0.04). In summary, women with lower BMD had increased arterial stiffness. There was no relationship between BMD and atherosclerosis. In conclusion, age, hypertension, and BMD are independent predictors of higher arterial stiffness. Vascular changes are related to bone mineral loss, suggesting lower BMD may increase cardiovascular risk in African-Americans.

Quantification of Vascular Calcifications on Digitized Mammograms

Conference Paper

Jun 2010
Lect Notes Comput Sci

In this paper, it’s presented an automatic quantification computer algorithm of breast arterial calcifications in digital mammograms, using image processing techniques, to be used as a quantitative cardiovascular risk or diabetes indicator for women. The proposed image processing algorithm is composed of two main steps: a detection phase, using a combination of the line operator method with edge detection, and a segmentation phase which use a thresholding technique to obtain seeds for a region growing algorithm. Obtained results shows a good agreement with ground truth images of calcified vessels which have been hand–segmented by an experienced radiologist with a high degree of detail and quality .

The Risk for Medial Arterial Calcification in CKD

Article

Dec 2011
CLIN J AM SOC NEPHRO

CKD is a risk factor for medial artery calcification, but the CKD stage at which this risk begins is unknown. Because breast arterial calcification (BAC) is a marker of generalized medial arterial calcification, mammography was used to detect medial arterial calcification in women with different CKD stages. This was a retrospective, cross-sectional study of women with and without CKD matched for age and diabetes and identified from mammograms obtained in 2006-2011. BAC was scored as present or absent per visual inspection. A total of 146 women with stage 3 CKD and 54 with stage 4/5 CKD were identified. An additional 21 patients with ESRD were identified and added to a previous cohort of 71 patients. Mean age was 64 years for CKD 3, 63 for CKD 4, and 59 for ESRD. Half of each group had diabetes. Compared with controls, the odds ratios for BAC were 1.44 in CKD 3 (95% confidence interval [CI], 0.82-2.53), 2.69 in CKD 4 (95% CI, 1.14-6.33), and 7.19 in ESRD (95% CI, 3.77-13.7) and did not differ with diabetic status or race. In a multivariable logistic model, age (P<0.001) and estimated GFR (P=0.005) were independent predictors of BAC. The odds ratio for BAC increased 4% for each milliliter per minute per 1.73 m(2) decrease in estimated GFR. The prevalence of BAC in CKD was increased in each decade of age over 49 years. CKD is an independent risk factor for medial arterial calcification.

Prevalence of breast arterial calcification by mammography contributes to breast cancer

Article

Full-text available

Jun 2011
Breast Canc

Mammographic breast arterial calcifications (BACs) are regarded as aging-related benign changes in breast cancer screening practices. BACs have recently attracted attention, because several researchers proposed using them as a surrogate marker of arteriosclerosis or osteoporosis. No studies have thus far evaluated an association between BACs and breast cancer, however. The percentage of BAC positivity was compared between a group of women aged 40 years or older with breast cancer detected in 2004 through 2009, and a group of women of the same age range in whom breast cancer was not detected by screening mammography in 2009. The BAC-positive rate in the group of 243 breast cancer patients was 9.88% (24 of the 243) and was lower than that in the group of women without breast cancer, 14.34% (506 of 3528 women). The analysis by age revealed that the differences in this parameter between the two groups were significant in women aged 60 years or older. Multivariate analysis including demographic characteristics revealed that when adjusted for age and body weight, BAC positivity was a significant risk factor for breast cancer. The study results suggest that BAC positivity and, in turn, arteriosclerosis may have an antinomic relationship with breast cancer.

Assessing breast arterial calcification in mammograms and its implications for atherosclerotic cardiovascular disease risk

Article

Mar 2024

Breast arterial calcification is associated with sarcopenia in peri- and post-menopausal women

Article

Apr 2024
CLIN IMAG

Associations between bone mineral density and abdominal aortic calcification: Results of a nationwide survey

Article

Feb 2024

Assessing cardiovascular risk with mammography and non-contrast chest CT: A review of the literature and clinical implications

Article

Sep 2023
CLIN IMAG

Osteoporosis was associated with severe abdominal aortic calcification based on a cross-sectional study

Article

Dec 2021

Abdominal aortic calcification and osteoporosis are age-related diseases. Based on a nationally representative US population, we concluded that osteoporosis may be independently associated with severe abdominal aortic calcification, which could improve our insights into the prevention and management of vascular disease.IntroductionAbdominal aortic calcification (AAC) and osteoporosis are age-related diseases and share similar pathological mechanisms. However, the association between osteoporosis and AAC is uncertain.MethodsA total of 3134 participants with complete record of AAC score calculated from dual-energy X-ray absorptiometry (DXA) were enrolled from the National Health and Nutrition Examination Survey (NHANES) 2013–2014. The diagnosis of osteoporosis was obtained from self-reported interview. The baseline covariates were compared between participants with and without osteoporosis. Multivariable logistic regression was performed to examine the association between abdominal aortic calcification and osteoporosis.ResultsCompared with those without osteoporosis, participants with osteoporosis had higher AAC scores. Osteoporosis was positively associated with higher odds of severe AAC (OR = 2.65; 95%CI, 1.89–3.71; P < 0.001), and the association was not altered (OR = 2.17; 95%CI, 1.23–3.83; P = 0.008) after adjusting for numerous covariates.Conclusions Our findings suggest that osteoporosis may be independently associated with severe abdominal aortic calcification.

Breast Arterial Calcium

Article

Mar 2019

In 2018, cardiovascular disease (CVD) was the leading cause of death among women, and current CVD prevention paradigms may not be sufficient in this group. In that context, it has recently been proposed that detection of calcification in breast arteries may help improve CVD risk screening and assessment in apparently healthy women. This review provides an overview of breast arterial anatomy; and the epidemiology, pathophysiology, and measurement of breast artery calcium (BAC); and discusses the features of the BAC-CVD link. The potential clinical applications that BAC may offer for CVD prevention in the context of current clinical practice guidelines and recommendations are also discussed. Finally, current gaps in evidence gaps are outlined, and future directions in the field are explored with a focus on the implementation of BAC mammography as a CVD risk-screening tool in routine clinical practice.

Systematic review and meta-analysis for the association of bone mineral density and osteoporosis/osteopenia with vascular calcification in women

Article

May 2016

Aim: The relationships of osteoporosis/osteopenia and bone mineral density (BMD) with vascular calcification (VC) remain controversial. Thus, we performed this systematic review and meta-analysis to evaluate the association between BMD, osteoporosis/osteopenia risk and VC. Methods: PubMed, Embase and Springer databases were searched from inception to March, 2015 for studies involving the association of vascular calcification with BMD and osteopenia/osteoporosis in women. A manual search of the references cited in the publications was also employed for more relevant studies. The heterogeneity was assessed using Cochran's Q statistic and I(2) test. Weighted mean difference (WMD) or odds ratio (OR) and 95% confidence interval (CI) in the VC group and control group were appropriately pooled. Results: Four studies were enrolled in the meta-analysis. The pooled effects indicated that the spine BMD (WMD = -0.08, 95% CI: -0.11 to -0.06) and hip BMD (WMD = -0.06, 95% CI: -0.10 to -0.07) in VC group were significantly lower than those in control group, respectively. Moreover, patients with VC were prone to develop osteoporosis (OR = 4.39, 95% CI: 2.82-6.83) and osteopenia (OR = 1.72, 95% CI: 1.14-2.60). Conclusion: The results suggest that patients with VC have lower lumbar spine and hip BMD levels and increased risk for developing osteoporosis/osteopenia. Thus, VC patients should be evaluated for the presence of osteoporosis/osteopenia, as well as susceptibility to fractures.

Relationship between carotid atherosclerosis and lumbar spine and hip osteoporosis in acute myocardial infarction

Article

Jan 2014

Molecular mechanism of vascular calcification with aging

Article

Jun 2015

Hironori NAKAGAMI

Breast arterial calcification and cardiovascular risk

Article

Jan 2015

David Barlow

Breast arterial calcifications: A systematic review and meta-analysis of their determinants and their association with cardiovascular events

Article

Dec 2014

Breast arterial calcifications (BAC), regularly observed at mammography, are medial calcifications and as such an expression of arteriosclerosis. Our objective was to evaluate and summarize the available evidence on the associations of BAC with cardiovascular risk factors and cardiovascular risk. A systematic literature review and meta-analysis were conducted. Embase and PubMed databases were searched. After critical appraisal, odds ratios were extracted from studies of moderate or good quality that examined risk factors for BAC or associations of BAC with cardiovascular disease. Random effects model meta-analyses were used to calculate pooled odds ratios and 95% confidence intervals (95%CIs). BAC prevalence is around 12.7% among women in breast cancer screening programs. Increasing age (pooled OR 2.98 [95%CI 2.31-3.85] for every 10 years), diabetes (pooled OR: 1.88 [95%CI 1.36-2.59]) and parity as opposed to nulliparity (pooled OR 3.43 [95%CI 2.23-5.27]) are associated with higher BAC prevalence. Smoking is associated with lower BAC prevalence (pooled OR 0.48 [95%CI 0.39-0.60]). No associations were found with hypertension, obesity or dyslipidemia. Although longitudinal studies (n = 3) were scarce, BAC appear to be associated with an increased risk of cardiovascular disease events (adjusted hazard ratios for coronary heart disease ranging from 1.32 [95%CI 1.08-1.60] to 1.44 [95%CI1.02-2.05]). BAC appear to be associated with an increased risk of cardiovascular disease events, while only being associated with some of the known cardiovascular risk factors, illustrating that medial arterial calcification might contribute to cardiovascular disease through a pathway distinct from the intimal atherosclerotic process. Copyright © 2014. Published by Elsevier Ireland Ltd.

Breast arterial calcifications and carotid intima-media thickness and haemodynamics: Is there any association?

Article

Full-text available

Feb 2014
ANADOLU KARDIYOL DER

In this study, we aimed to research the relation between breast arterial calcifications (BACs) detected on mammography and two well-known markers of cardiovascular diseases-carotid artery intima-media thickness (C-IMT) and haemodynamics parameters like carotid peak-systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI). The study group consisted of 50 consecutive BAC (+) women and the control group consisted of 55 BAC (-) women. In all participants, BAC was diagnosed using mammography and C-IMT was measured using B-mode and Doppler ultrasonography. BAC was defined as two linear calcification depositions in a conical periphery or as calcific rings at the mammographic evaluation. Doppler spectrum samples were obtained from 2 cm proximal to the main carotid artery bifurcation. Postmenopausal female patients ranging in age from 40 to 86 included in this study. When the groups were adjusted for age, a statistically significant difference was found between mean C-IMT of BAC (+) and BAC (-) groups (0.81±0.2 vs. 0.69±0.2 mm; p<0.001). No significant differences were observed between BAC (+) and BAC (-) groups in terms of PSV, EDV, RI. The findings of the present study suggest that BAC, diagnosed by mammography, is independently associated with C-IMT. C-IMT measurement is suggested as a useful tool to detect early atherosclerotic changes. However, haemodynamic variables (PSV, EDV, RI) were not statistically different between the BAC (+) and BAC (-) groups. Prospective larger cohort studies are needed to further elucidate whether BAC is an independent risk factor for cardiovascular disease.

Association of breast vascular calcifications with low bone mass in postmenopausal women

Article

Nov 2013
CLIMACTERIC

Background: In developing countries, there is a deficiency of densitometers with which to screen the population for osteoporosis. Thus, strategies with which to select patients for a bone density test are desirable. Objective: To determine whether breast vascular calcifications (BVCs) may be employed to identify postmenopausal women with osteoporosis/osteopenia. Methods: This was a cross-sectional study of postmenopausal women subjected to bilateral mammography and bone densitometry (DXA) of the spine and hip. A medical interview registered possible confounding factors, such as age, length of menopause, previous use of postmenopausal hormone therapy, family history of osteoporosis, smoking, alcoholism, hypertension, diabetes, cardiovascular diseases, and medication use. Results: The study included 211 postmenopausal women aged 62.1 ± 9.3 years, 38 of whom (18.0%) exhibited BVC. Osteoporosis was detected in 36 (17.1%), and a T-score < 21.0 for any site was found in 164 (77.7%). No statistically significant difference was found between the groups without BVC (n = 173) and with BVC (n = 38) for the prevalence of 'osteoporosis' or 'moderate/severe osteopenia or osteoporosis' at the spine or at any other site. There was a difference between the groups in terms of age (59.0 ± 7.8 vs. 71.9 ± 8.9 years, respectively; p < 0.001), sedentary lifestyle (57.8% vs. 84.2%, respectively; p = 0.002), smoking (27.7% vs. 7.9%, respectively; p = 0.009), and high blood pressure (65.3% vs. 92.1%, respectively; p = 0.001). Logistic regression analysis confirmed the lack of statistical significance for BVC as a predictor of an osteoporosis diagnosis. Sensitivity values of BVCs to detect osteoporosis or osteopenia ranged from 17.9% to 25.0%. Conclusion: BVCs have been shown to be inadequate to identify postmenopausal women with osteoporosis or osteopenia.

Identification of breast vascular calcium deposition in digital mammography by linear structure analysis

Article

May 2012

Computerized detection of vascular calcium depositions in mamagraphy is a new research topics, which is driven by the clinical hypothesis of the association with many related cardiovascular diseases. In several previous studies [7, 9], calcification cue plays a very important role in the computerized analysis. We observe that vascular calcium depositions can be identified with high confidence if they appear in a bright railway pattern. Accordingly, a linear structure analysis method is introduced in this study to detect most true calcifications and also keep the false positives as little as possible. The proposed method is tested with 40 mammograms and achieves performance of 93.8±1.3% in sensitivity and 84.7±3.9% in specificity. The output of this linear structure analysis may provide more reliable calcification cue for the subsequent vessel tracking process, which will be investigated in the future.

Clinical profile of Spanish postmenopausal women with a diagnosis of osteoporosis and risk factors for endometrial pathology, breast cancer, and cardiovascular disease

Article

Mar 2013

Objective: GINERISK was designed to assess the clinical profile of Spanish postmenopausal women with a diagnosis of osteoporosis and to establish the presence of other risk factors. Methods: In this Spanish cross-sectional, epidemiological, observational study, gynecologists sequentially invited postmenopausal women with osteoporosis under their care to complete a predefined questionnaire during a routine visit. Risk factors for bone fractures, endometrial pathology, breast cancer, and cardiovascular disease were assessed. Results: In addition to being postmenopausal and having diagnosed osteoporosis, 49.8% (2,070/4,157) of eligible participants had one or more risk factors for bone fractures, 96.8% (4,023/4,157) had one or more risk factors for breast cancer, and 83.4% (3,469/4,157) had one or more risk factors for cardiovascular disease. Furthermore, 20.1% (n = 835) of the women presented with high cardiovascular risk, 16.6% (n = 692) were at high risk for bone fractures, and 14.5% (n = 423) were at high risk for developing breast cancer in the next 5 years, whereas only 9.2% (n = 301) of participants were identified as having high endometrial risk. Conclusions: In addition to the increased risk of bone fractures, women with osteoporosis are also at risk for endometrial pathology, breast cancer, and cardiovascular disease. These risks should be evaluated and taken into consideration when choosing an osteoporosis treatment for postmenopausal women.

Indicators of systemic disease on mammography

Article

Jan 2013

Kathryn Faguy

In addition to breast cancer and other conditions limited to the breast, mammograms sometimes reveal signs of systemic disease. These signs include breast arterial calcifications, axillary lymphadenopathy, dilated veins in the breast, breast edema and skin thickening, and masses not associated with cancer or a benign breast condition. This article discusses the indicators of systemic disease seen on mammograms and some of the many diseases they may signify. Several case studies are presented.

Automated Delineation of Calcified Vessels in Mammography by Tracking With Uncertainty and Graphical Linking Techniques

Article

Sep 2012
IEEE T MED IMAGING

As a potential biomarker for women's cardiovascular and chronic kidney diseases, breast arterial calcification (BAC) in mammography has become an emerging research topic in recent years. To provide more objective measurement for vascular structures with calcium depositions in mammography, a new computerized method is introduced in this paper to delineate the calcified vessels. Specifically, we leverage two underlying cues, namely calcification and vesselness, into a multiple seeded tracking with uncertainty scheme. This new vessel-tracking scheme generates plenty of sampling paths to describe the complicated topology of the vascular structures with calcium depositions. A compiling and linking process is further carried out to organize the sampling paths together to be the vessel segments that likely belong to the same vessel tract. The proposed method has been evaluated on 63 mammograms, by comparison with manual delineations from two experts using various assessment metrics. The experiment results confirm the efficacy and stability of the proposed method, and also indicate that the proposed method can be potentially used as a convenient BAC measurement tool in replacement of the trivial and tedious manual delineation tasks.

Osteoporosis - A risk factor for cardiovascular disease?

Article

Aug 2012
NAT REV RHEUMATOL

Osteoporosis is a serious health problem worldwide that is associated with an increased risk of fractures and mortality. Vascular calcification is a well-defined independent risk factor for cardiovascular disease (CVD) and mortality. Major advances in our understanding of the pathophysiology of osteoporosis and vascular calcification indicate that these two processes share common pathogenetic mechanisms. Multiple factors including proteins (such as bone morphogenetic proteins, receptor activator of nuclear factor κB ligand, osteoprotegerin, matrix Gla protein and cathepsins), parathyroid hormone, phosphate, oxidized lipids and vitamins D and K are implicated in both bone and vascular metabolism, illustrating the interaction of these two, seemingly unrelated, conditions. Many clinical studies have now confirmed the correlation between osteoporosis and vascular calcification as well as the increased risk of CVD in patients with osteoporosis. Here, we explore the proposed mechanistic similarities between osteoporosis and vascular calcification and present an overview of the clinical data that support the interaction between these conditions.

Breast arterial calcification and hypertension associated with vertebral fracture

Article

Full-text available

Nov 2011

Arterial calcification and osteoporosis commonly accompany one another in postmenopausal women. Hypertension is a known contributing factor to arterial calcification. Thus, we aimed to investigate any associations between hypertension, arterial calcification and vertebral fractures in a cross-sectional study in Japanese postmenopausal women. The medical histories of 421 postmenopausal Japanese women diagnosed with hypertension, diabetes mellitus or hyperlipidemia were investigated. Bodyweight, body height and ultradistal bone mineral density (BMD) were measured. The prevalent vertebral fractures were diagnosed by a semiquantitative method, and the number of breast arterial calcifications (BAC) was investigated by mammography screening. Patients with vertebral fractures were of a significantly higher age, lower height, lower ultradistal BMD and had a higher number of BAC compared with those without vertebral fractures. Furthermore, a significantly higher prevalence of hypertension was observed in the patients with vertebral fractures as compared with those without. A multivariate stepwise regression analysis using these variables for vertebral fractures showed that the significant odds ratios (OR) of age (OR 1.76, 95% CI 1.11-2.77, P = 0.016), the prevalence of BAC (OR 2.52, 95% CI 1.62-3.93, P < 0.001) and the presence of hypertension (OR 1.76, 95% CI 1.11-2.80, P = 0.017) were found as significant independent risk factors for vertebral fractures. This is the first report of the relevance of BAC or hypertension to vertebral fractures in Japanese women. The results suggest that hypertension, BAC and osteoporotic fractures share a common metabolic pathway in their pathogenesis.

Vascular Calcification Is Associated with Cortical Bone Loss in Chronic Renal Failure Rats with and without Ovariectomy: The Calcification Paradox

Article

Aug 2011
AM J NEPHROL

Increased bone loss has been associated with the development of vascular calcification in patients with chronic renal failure (CRF). In this study, the effect of impaired bone metabolism on aortic calcifications was investigated in uremic rats with or without ovariectomy. CRF was induced by administration of a 0.75% adenine/2.5% protein diet for 4 weeks. In one group, osteoporosis was induced by ovariectomy (CRF-OVX), while the other group underwent a sham-operation instead (CRF). A third group consisted of ovariectomized rats with normal renal function (OVX). At regular time intervals throughout the study, bone status and aortic calcifications were evaluated by in vivo micro-CT. At sacrifice after 6 weeks of CRF, bone histomorphometry was performed and vascular calcification was assessed by bulk calcium analysis and Von Kossa staining. Renal function was significantly impaired in the CRF-OVX and CRF groups. Trabecular bone loss was seen in all groups. In the CRF-OVX and CRF groups, trabecular bone density was restored after adenine withdrawal, which coincided with cortical bone loss and the development of medial calcifications in the aorta. No significant differences with regard to the degree of aortic calcifications were seen between the two CRF groups. Neither cortical bone loss nor calcifications were seen in the OVX group. Cortical bone loss significantly correlated with the severity of vascular calcification in the CRF-OVX and CRF groups, but no associations with trabecular bone changes were found. Cortical rather than trabecular bone loss is associated with the process of calcification in rats with adenine- induced CRF.

Osteoprotegerin-deficient mice develop early onset osteoporosis and arterial calcification

Article

Full-text available

May 1998
GENE DEV

Osteoprotegerin (OPG) is a secreted protein that inhibits osteoclast formation. In this study the physiological role of OPG is investigated by generating OPG-deficient mice. Adolescent and adult OPG-/- mice exhibit a decrease in total bone density characterized by severe trabecular and cortical bone porosity, marked thinning of the parietal bones of the skull, and a high incidence of fractures. These findings demonstrate that OPG is a critical regulator of postnatal bone mass. Unexpectedly, OPG-deficient mice also exhibit medial calcification of the aorta and renal arteries, suggesting that regulation of OPG, its signaling pathway, or its ligand(s) may play a role in the long observed association between osteoporosis and vascular calcification.

Breast Vascular Calcification and Risk of Coronary Heart Disease, Stroke, and Heart Failure

Article

Full-text available

Jun 2004

Vascular calcification holds promise as a useful cardiovascular risk maker. Our objective was to examine the association between breast vascular calcification and risk of cardiovascular disease (CVD) outcomes. A cohort study was performed among 12,761 women, 40-79 years of age at baseline (1968-1973), who attended multiphasic health checkups that included mammography. The outcome measures included coronary heart disease (CHD), ischemic stroke, transient ischemic attack (TIA), hemorrhagic stroke, and heart failure, ascertained using discharge diagnosis codes and death records through December 31, 2000 (median follow-up, 24.8 years). Breast vascular calcification was present in 424 (3%) women. It was independently and positively associated with age, high parity, and diabetes and inversely associated with education level and current cigarette smoking. After adjustment for age, education level, race, cigarette smoking, alcohol use, body mass index (BMI), serum total cholesterol, hypertension, diabetes, parental history of myocardial infarction (MI), parity, and hormone replacement therapy (HRT), breast vascular calcification was associated with a 1.32-fold increased risk of CHD (95% confidence interval [CI] 1.08-1.60), a 1.41-fold increased risk of ischemic stroke (95% CI 1.11-1.78), and a 1.52-fold increased risk of heart failure (95% CI 1.18-1.98). Breast vascular calcification detected as part of a screening mammogram was an independent risk factor for multiple cardiovascular outcomes among women. The value of mammography in cardiovascular risk stratification deserves further investigation.

Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis. Report of a WHO Study Group

Book

Jan 1994
WHO TECH REP SER

Osteoporosis and Coronary Atherosclerosis in Asymptomatic Postmenopausal Women

Article

Mar 1998

Estrogen deficiency is a risk factor for osteoporosis and coronary artery disease. Osteoporosis can be evaluated by measuring bone mineral density (BMD). Coronary atherosclerotic burden can be evaluated by measuring coronary calcium using electron beam computed tomography (EBT) of the heart. We compared coronary calcium scores in 45 asymptomatic postmenopausal women with normal and low BMD. BMD of the lumbar spine and proximal femur was measured by dual X-ray absorptiometry (DXA), and coronary calcium was measured quantitatively by EBT. Women were divided into control, osteopenia, and osteoporosis groups based on the T score of the lumbar spine. Women were similar in age, years since menopause, height, weight, and body mass index (BMI). BMD +/- SD (g/cm2) of L1-L4 was 0.96 +/- 0.11, 0.83 +/- 0.03, and 0.73 +/- 0.05, in control, osteopenia, and osteoporosis group, respectively. The total coronary calcium score +/- SD (relative units) was 41.9 +/- 83.1, 115.1 +/- 181.9, and 221.7 +/- 355.4 for control, osteopenia, and osteoporosis group, respectively; the score was significantly higher in the osteoporosis than in the control group. This study provides initial data suggesting that women with osteoporosis may have a higher risk of developing coronary atherosclerosis.

Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study GroupWorld Health Organization (WHO)World Health Organ Tech Rep Ser19948431129

Article

Dec 1994

J.A. Kanis

The criteria required for an effective screening strategy for osteoporosis are largely met in Caucasian women. The disease is common and readily diagnosed by the measurement of bone mineral with single- or dual-energy absorptiometry. Such measurements have high specificity but lower sensitivity, so that the value of the technique is greater for those identified as being at higher risk. Against this background there is little evidence that osteoporosis can usefully be tackled by a public health policy to influence risk factors such as smoking, exercise and nutrition. This suggests that it is appropriate to consider targetting of treatment with agents affecting bone metabolism to susceptible individuals. Since the main benefits of the use of hormone replacement therapy (HRT) are probably on cardiovascular morbidity, the major role for selective screening is to direct non-HRT interventions. An appropriate time to consider screening and intervention is at the menopause, but screening at later ages is also worthy of consideration. Since the cost of screening is low and that of bone-active drugs is high, the selective use of screening techniques will improve the cost-benefit ratio of intervention.

Current practice of screening mammography in the United States: Data from the National Survey of Mammography Facilities

Article

Jan 1994

To describe the extent to which screening mammography (SCM) has been organized according to the public health concept of low-cost, high-quality, and population-based screening, selected indicators of U.S. mammography facilities were evaluated. Data from the National Cancer Institute's phase I of the National Survey of Mammography Facilities were analyzed. This data base consists of questionnaire information obtained in 1992 from a 10% random sample of U.S. mammography facilities. Of 1,057 facilities, 634 (60%) distinguished SCM from diagnostic mammography (DXM). In facilities providing SCM (n = 535), 477 (89%) used the mediolateral oblique (MLO) view and/or the craniocaudal (CC) view. While 898 (85%) of all facilities requested clinical follow-up of abnormal mammograms, only 285 (27%) facilities actually received this information. Only 137 (13%) facilities operated at high volume (> or = 15 mammograms per day per machine), and 211 (20%) used batch interpretation. Average cost of a screening mammogram was

89 (range,

10-$225). While more facilities are distinguishing SCM from DXM and obtain MLO and CC views, SCM does not appear to be organized for high volume and low cost.

Breast arterial calcifications: Association with diabetes mellitus and cardiovascular mortality: Work in progress

Article

Nov 1996

To determine the relationship between breast arterial calcification, diabetes mellitus, and subsequent cardiovascular and noncardiovascular mortality. A prospective cohort study was carried out in 12,239 women aged 50-68 years who participated in a breast cancer screening program. The screening mammograms were coded for the presence of breast arterial calcification. Diabetes (n = 442) was defined as use of insulin or oral hypoglycemic agents, use of a restricted diet for diabetes, or the presence of glucosuria. Data were available from questionnaires and urine glucose tests. Hazard ratios, which were adjusted for age, smoking, parity, and obesity, were calculated from mortality data after 16-19 years of follow-up. Breast arterial calcification was seen in 9.0% (1,107 of 12,239) of all women and in 15.4% (68 of 442) of the diabetic women. An excess cardiovascular mortality of 40% (hazard ratio = 1.4; 95% confidence interval = 1.1, 1.8) was found for all women with breast arterial calcification. In diabetic women, the presence of breast arterial calcification was associated with a 90% (hazard ratio = 1.9; 95% confidence interval = 1.1, 3.2) increase in cardiovascular mortality. Breast arterial calcification represents an independent risk factor for cardiovascular mortality in women over 50 years of age, especially in those with diabetes.

Bone Changes and Carotid Atherosclerosis in Postmenopausal Women

Article

Sep 1997

Because of increased life expectancy, most postmenopausal women today suffer from osteoporosis and atherosclerotic diseases, which are currently considered unrelated diseases. Our study was aimed at analyzing relations between bone mineral density (BMD) and ultrasonographic assessment of carotid wall characteristics. The relation of carotid atherosclerosis to BMD was examined in 30 postmenopausal women aged 67 to 85 years. High-resolution B-mode ultrasonography was performed, and the severity of carotid atherosclerosis was determined by plaque score. BMD was measured by dual-energy x-ray absorptiometry. The correlation of plaque score with low total BMD was r = .549 (P < .002). Multiple linear regression analysis indicated significant correlation of plaque score with total cholesterol level and low total BMD. Our results suggest a relation between carotid atherosclerosis, one of the major causes of ischemic cerebrovascular diseases, and osteoporosis.

The association between low bone mass at the menopause and cardiovascular mortality

Article

Mar 1999
AM J MED

Low bone mineral density in late postmenopausal women has been associated with increased nontrauma mortality. We investigated whether bone mass in women soon after menopause was also associated with the risk of mortality in later life. Between 1977 and 1988, two samples of healthy women were enrolled; one group soon after the menopause (age 50 +/- 2 years [mean +/- SD], n = 309) and another later after menopause (age 70 +/- 2 years, n = 754). The baseline visit included a medical examination and a measurement of bone mineral content in the distal forearm. In 1994, vital status was checked. All causes of death were registered, excluding those that were due to trauma or suicide. Multivariate relative risks (RR) and 95% confidence intervals (CI) were determined. In the early postmenopausal group, each decrease of one SD (0.4 g/cm) in bone mineral content was associated with a 43% increase in mortality (RR = 1.4; 95% CI 1.0 to 2.0; P < 0.05). When only cardiovascular death was considered, the relative risk of dying within 17 years of the menopause was increased 2.3-fold (95% CI 1.0 to 5.3; P < 0.05). Correspondingly, a 70-year-old woman with a bone mineral content 1 SD below the mean for her age had a 1.8-fold increased risk of dying from cardiovascular disease (95% CI 1.0 to 3.2; P = 0.06). Expressed as quartiles, women with bone mass in the lowest quartile had twice the risk of cardiovascular death compared with those in the highest quartile. A prevalent vertebral compression fracture in the late postmenopausal group was independently associated with cardiovascular death (RR = 2.0; 95% CI 1.4 to 3.3; P = 0.004). Low bone mineral content at the menopause is a risk factor for increased mortality in later life, especially from cardiovascular disease.

Breast artery calcium on routine mammography as a potential marker for increased risk of cardiovascular disease

Article

Aug 2000
AM J CARDIOL

Bone Mineral Density in Acute Stroke Patients Low Bone Mineral Density May Predict First Stroke in Women

Article

Feb 2001
STROKE

Osteoporosis and stroke share several risk factors, including age, smoking, low physical activity, and hypertension. Thus, low bone mineral density (BMD) and high stroke risk may be related. We examined the relationship between BMD and acute stroke in noninstitutionalized men and women aged >/=60 years. Sixty-three stroke patients (33 women and 30 men) and 188 control subjects from the general population were included. BMD was measured by using dual-energy x-ray absorptiometry at both proximal femurs. The measurements of the stroke patients were performed 6 days after the onset of stroke. The BMD at the femoral neck in the female stroke patients was 8% lower than in the control subjects (P:=0.007). In men, no difference in BMD between the stroke patients and their controls was found. Women with BMD values in the lowest quartile had a higher risk of stroke than women with BMD values in the highest quartile (OR 4.8), and the probability value for linear trend over the quartiles was statistically significant (P:=0.003). The OR for stroke increased 1.9 per SD (0.13 g/cm(2)) reduction in BMD, and the association between low BMD and stroke in women remained significant when the analysis was adjusted for potential confounders. Female, but not male, stroke patients have lower BMD than population controls. Low BMD may predict stroke in women.

Insights into the mechanism of vascular calcification

Article

Aug 2001
AM J CARDIOL

Kristina I. Boström

Vascular calcification is common and clinically significant in atherosclerosis and heart failure. It was long believed to be an end-stage process of "passive" mineral precipitation. However, there is now a growing awareness that vascular calcification is a biologically regulated phenomenon. It has many similarities to bone formation, and ectopic bone is a well-documented part of vascular calcification. This implies that alterations in vascular cell differentiation, extensive or localized, are an integral part of vascular calcification. Matrix gamma-carboxylated glutamate (GLA) protein (MGP)-deficient mice develop extensive vascular calcification with replacement of the media by progressively calcifying cartilage. A potential mechanism that explains these findings is MGP interference with bone morphogenetic proteins-potent inducers of cartilage and bone.

Bone loss and the progression of abdominal aortic calcification over 25 year period: The Framingham Heart Study

Article

Jun 2001

Vascular calcification and osteoporosis are common age-related processes that are prominently displayed on routine lateral lumbar spine radiographs as dense calcium mineral deposits of the aorta that lie adjacent to osteopenic vertebrae. Using a population-based cohort of older men and women, we tested the hypothesis that the progression of vascular calcification of the abdominal aorta should be greatest in those individuals with the greatest amount of bone loss. From the original population-based Framingham Heart Study cohort, 364 women and 190 men had lateral lumbar spine and hand radiographs performed between 1966 and 1970 and repeated between 1992 and 1993. The lateral lumbar films were read for the presence of aortic calcification using a semiquantitative method, and the hand films were read for second metacarpal relative cortical area (MCA). Using multivariate regression techniques, the 25-year progression of the abdominal aortic calcification index was examined in relation to the change in the MCA, while adjusting for recognized risk factors for atherosclerotic cardiovascular disease. During the 25 years of follow-up, the MCA decreased by 22.4% in women (from 79.6 +/- 7.8 (SD) to 61.8 +/- 10.3) and by 13.3% in men (from 80.6 +/- 6.9 to 69.9 +/- 8.3). The aortic calcification score increased over eightfold in women (from 1.2 +/- 2.7 (SD) to 9.9 +/- 6.7) and sixfold in men (from 1.6 +/- 2.8 to 9.6 +/- 6.3). There was a significant association between percent change in MCA and change in aortic calcification index (P = 0.01) in women after controlling for all potential confounders. No association was observed in men (P = 0.50), including the 50% of men with the greatest bone loss. This is the first longitudinal study to show that women with the greatest magnitude of bone loss also demonstrate the most severe progression of abdominal aortic calcification, suggesting that the two processes may be related.

Mineral Exploration: Search for the Mechanism of Vascular Calcification and Beyond: The 2003 Jeffrey M. Hoeg Award Lecture

Article

Nov 2003
ARTERIOSCL THROM VAS

Research in the area of vascular calcification has grown rapidly in the past decade, and there is a greater understanding of its active regulatory mechanisms. This brief review covers the ideas presented in the 2003 Jeffrey M. Hoeg Award lecture, including the concepts that bone tissue forms in the artery wall in patients with atherosclerosis, that vascular cells undergo osteoblastic differentiation, that bone morphogenetic protein and matrix GLA protein regulate vascular calcification in opposition, that inflammatory cytokines and lipids promote vascular cell calcification but inhibit osteoblastic cell differentiation, that these same factors promote differentiation of bone-resorbing osteoclasts, and that the artery wall may contain osteoclast-like cells with the potential to resorb calcium mineral. The review closes with a mention of therapeutic possibilities and an evolutionary paradigm to explain the reciprocal responses of vascular and bone mineralization to inflammation.

Low Bone Mineral Density in the Hip as a Marker of Advanced Atherosclerosis in Elderly Women

Article

Aug 2003

Previous studies indicate that low bone mineral density (BMD) in the hip is a useful predictor of cardiovascular mortality among the elderly. The objective of this study was to investigate whether low hip BMD is directly associated with the severity of atherosclerosis. The per-protocol population consisted of 963 women aged 60-85 years. Study variables were aortic calcification (AC) graded on lateral lumbar radiographs, BMD at various anatomic sites (distal radius, lumbar spine, proximal femur) measured by DXA, information on various risk factors, and medical history. After adjustment for age, BMD at the proximal femur, but not at the radius or spine BMD, showed statistically significant association with the severity of AC (r = -0.12-17, P < 0.001). Age, years since menopause, BMI, level of education, current and previous smoking, and weekly fitness activity were significant common risk factors (all P < 0.05) with contrasting influence on AC and hip BMD. In a multiple regression model, AC contributed significantly and independently to the variation in hip BMD (beta = -0.10, P = 0.004). Impaired blood flow represented by 40 women with documented history of intermittent claudication was not an independent contributor and did not alter the association between AC and hip BMD. However, AC and demineralization in the hip was particularly severe in women with intermittent claudication accompanied by a higher prevalence of coronary heart disease compared with age-matched controls (all P < 0.001). In conclusion, severe osteoporosis in the hip may indicate advanced atherosclerosis and thereby an increased risk for not only hip fractures but also for coronary heart disease. The results further emphasize that osteoporosis in the hip and peripheral vascular disease are linked by common risk factors and pathomechanisms.

Osteoporosis and Cardiovascular Disease: Brittle Bones and Boned Arteries, Is There a Link?

Article

Mar 2004

Both osteoporosis and cardiovascular disease (CVD) are major public health problems leading to increased morbidity and mortality. Although traditionally viewed as separate disease entities that increase in prevalence with aging, accumulating evidence indicates that there are similar pathophysiological mechanisms underlying both diseases. In addition to menopause and advanced age, other risk factors for CVD such as dyslipidemia, oxidative stress, inflammation, hyperhomocystinemia, hypertension, and diabetes have also been associated with increased risk of low bone mineral density (LBMD). Elevated LDL and low HDL cholesterol are associated with LBMD, altered lipid metabolism is associated with both bone remodeling and the atherosclerotic process, which might explain, in part, the co-existence of osteoporosis and atherosclerosis in patients with dyslipidemia. Similarly, inflammation plays a pivotal role in both atherosclerosis and osteoporosis. Elevated plasma homocysteine levels are associated with both CVD and osteoporosis. Nitric oxide (NO), in addition to its known atheroprotective effects, appears to also play a role in osteoblast function and bone turnover. Supporting this notion, in a small randomized controlled trial, nitroglycerine (an NO donor) was found to be as effective as estrogen in preventing bone loss in women with surgical menopause. Statins, agents that reduce atherogenesis, also stimulate bone formation. Furthermore, bisphosphonates, used in the treatment of osteoporosis, have been shown to inhibit atherogenesis. Intravenous bisphosphonate therapy significantly decreases serum LDL and increases HDL in postmenopausal women. The exciting possibilities of newer pharmacological agents that effectively treat both osteoporosis and CVD hold considerable promise. However, it is important to emphasize that the current evidence linking both of these diseases is far from conclusive. Therefore, additional research is necessary to further characterize the relationship between these two common illnesses.

Vascular Calcification Mechanisms and Clinical Ramifications

Article

Aug 2004
ARTERIOSCL THROM VAS

Vascular calcification, long thought to result from passive degeneration, involves a complex, regulated process of biomineralization resembling osteogenesis. Evidence indicates that proteins controlling bone mineralization are also involved in the regulation of vascular calcification. Artery wall cells grown in culture are induced to become osteogenic by inflammatory and atherogenic stimuli. Furthermore, osteoclast-like cells are found in calcified atherosclerotic plaques, and active resorption of ectopic vascular calcification has been demonstrated. In general, soft tissue calcification arises in areas of chronic inflammation, possibly functioning as a barrier limiting the spread of the inflammatory stimulus. Atherosclerotic calcification may be one example of this process, in which oxidized lipids are the inflammatory stimulus. Calcification is widely used as a clinical indicator of atherosclerosis. It progresses nonlinearly with time, following a sigmoid-shaped curve. The relationship between calcification and clinical events likely relates to mechanical instability introduced by calcified plaque at its interface with softer, noncalcified plaque. In general, as calcification proceeds, interface surface area increases initially, but eventually decreases as plaques coalesce. This phenomenon may account for reports of less calcification in unstable plaque. Vascular calcification is exacerbated in certain clinical entities, including diabetes, menopause, and osteoporosis. Mechanisms linking them must be considered in clinical decisions. For example, treatments for osteoporosis may have unanticipated effects on vascular calcification; the converse also applies. Further understanding of processes governing vascular calcification may yield new therapeutic options for vascular disease.

[Vascular calcification mechanisms in uremia]

Article

Feb 2004
NEFROLOGIA

Aortic Calcification and the Risk of Osteoporosis and Fractures

Article

Sep 2004

We investigated the relation between computed tomography measures of aortic calcification and values for bone density and the number of fragility fractures in 2348 healthy, postmenopausal women. To determine whether increases in vascular calcification and bone loss progress in parallel, baseline values were compared with measurements obtained 9 months to 8 yr later in a subgroup of 228 women. Of the 2348 subjects studied, 70% had osteoporosis, 30% had at least one vertebral fracture, and 9% had at least one hip fracture. Aortic calcifications were inversely related to bone density and directly related to fractures. After adjusting for age and potential confounders, measures for aortic calcification predicted 26.1% of the variance in bone density (P < 0.001). Compared with women without calcification, the odds ratios for vertebral and hip fractures in those with calcification were estimated to be 4.8 (95% confidence interval, 3.6-6.5) and 2.9 (95% confidence interval, 1.8-4.8), respectively. The subgroup analysis of 228 women longitudinally studied showed that the percentage of yearly increase in aortic calcification accounted for 47% of the variance in the percentage rate of bone loss (P < 0.001). Moreover, a strong graded association was observed between the progression of vascular calcification and bone loss for each quartile. Women in the highest quartile for gains in aortic calcification had four times greater yearly bone loss (5.3 vs.1.3% yearly; P < 0.001) than women of similar age in the lowest quartile. Smaller, but highly significant differences were also found between all other quartiles. We conclude that aortic calcifications are a strong predictor for low bone density and fragility fractures.

Vascular Calcification and Osteoporosis—The Nature of the Nexus

Article

Oct 2004

Prevalence of Breast Arterial Calcifications in an Ethnically Diverse Population of Women

Article

May 2005
ANN EPIDEMIOL

Breast arterial calcifications (BAC) identified on routine mammography have been associated with coronary heart disease (CHD) risk factors including diabetes and hypertension, angiographically defined CHD, and increased cardiovascular mortality. Accumulating evidence suggests that the mammogram may be an important tool to identify women at risk for CHD, however, the epidemiology of BAC has been poorly defined and previous studies limited to white populations. The mammograms of 1905 consecutive women (51.2% Hispanic, 25.8% white, 15.3% black, 5.4% other, 2.2% Asian, ages 35-92 years) were evaluated for the presence of BAC and the number of calcified arteries. The overall prevalence of BAC was 29.4% and was significantly higher for Hispanics compared with whites (34.5% vs. 24.0%, p=0.0002) and lower for Asians compared with whites (7.1% vs. 24.0%, p < 0.02). Among BAC-positive women aged 65 years or less, blacks had more calcified arteries than whites (p < 0.01). The presence of BAC increased with age (p for trend < 0.0001). In age-adjusted models, older Hispanics were more likely to be BAC-positive than whites of similar age (p < 0.02). These results indicate that BAC varies significantly by age and race/ethnicity. These findings should be taken into consideration when designing future studies of BAC and CHD.

Usefulness of Bone Mineral Density to Predict Significant Coronary Artery Disease

Article

Oct 2005
AM J CARDIOL

Low bone mineral density (BMD) and coronary artery disease (CAD) share common risk factors. To investigate whether low BMD (osteoporosis and/or osteopenia) independently predicts CAD compared with traditional cardiovascular risk factors, a retrospective analysis was performed in consecutive ambulatory patients (n = 209, 89% women) who underwent dual-energy x-ray absorptiometry and coronary angiography within the same 12-month period. Angiograms were classified as showing significant CAD if > or =50% luminal narrowing in a major coronary artery was noted. Clinical variables associated with CAD (age, hypertension, diabetes, high fasting glucose level, smoking, family history of CAD, and dyslipidemia) were examined. Dual-energy x-ray absorptiometric scans were classified based on World Health Organization criteria: normal (T score >-1.0 SD), osteopenia (T score -1.0 to -2.5 SD), and osteoporosis (T score <-2.5 SD). Univariate and multivariate analyses were employed to determine whether low BMD independently predicts CAD. Univariate predictors of CAD were hypertension, smoking, diabetes, high fasting glucose level, dyslipidemia, family history of CAD, and low BMD. Multivariate predictors were hypertension, family history of CAD, fasting glucose level, and osteoporosis. Odds ratio for the prediction of angiographically documented CAD was highest for osteoporosis (odds ratio 5.6, 95% confidence interval 2.6 to 12.0, p <0.0001). In conclusion, low BMD appears to independently predict significant CAD in women, with a higher odds ratio than traditional risk factors. Our study is the first to report osteoporosis as a predictor of angiographically proved CAD in a population predominantly of women.

Bone loss and the progression of abdominal aortic calcification over a 25 year period: the Framingham Heart Study TABLE 2. Multivariate adjusted odds ratios (OR) and 95% confidence intervals (CI) for predictors of BAC Variable OR 95% CI Age

271-276

Dp Kiel
Li Kauppila
La Cupples
O Mt Hannan
Cj Donnell
Wilson

Kiel DP, Kauppila LI, Cupples LA, Hannan MT, O'Donnell CJ, Wilson PW 2001 Bone loss and the progression of abdominal aortic calcification over a 25 year period: the Framingham Heart Study. Calcif Tissue Int 68:271–276 TABLE 2. Multivariate adjusted odds ratios (OR) and 95% confidence intervals (CI) for predictors of BAC Variable OR 95% CI Age (10 yr)

JacobsenB2001Bonemineraldensityinacutestroke patients, low bone mineral density may predict first stroke in women

47-5

Jørgensenl
Engstadt

JørgensenL,EngstadT,JacobsenB2001Bonemineraldensityinacutestroke patients, low bone mineral density may predict first stroke in women. Stroke 32:47–5

Simonet WS 1998 Osteoprotegerindeficient mice develop early onset osteoporosis and arterial calcification

1260-1268

N Bucay
I Sarosi
Cr Duncan
S Morony
J Tarpley
C Capparelli
S Scully
Hl Tan
W Xu
Dl Lacey
Wj Boyle

Bucay N, Sarosi I, Duncan CR, Morony S, Tarpley J, Capparelli C, Scully S, Tan HL, Xu W, Lacey DL, Boyle WJ, Simonet WS 1998 Osteoprotegerindeficient mice develop early onset osteoporosis and arterial calcification. Genes Dev 12:1260 –1268