Vertebral fractures and abdominal aortic calcification in postmenopausal women. A cohort study

Abstract

Introduction: Vertebral fracture assessment (VFA) imaging with a bone densitometer can simultaneously detect prevalent vertebral fractures (VFs) and abdominal aortic calcification (AAC).

Objective: To study the relation between the prevalence of VFs using VFA in asymptomatic women and the prevalence and severity of AAC.

Design: This is a cross-sectional study.

Settings: Subjects were recruited in a third care center from asymptomatic women selected from the general population.

Participants: We enrolled 908 post-menopausal women with a mean age of 60.9 years ± 7.7 (50 to 91) with no prior known diagnosis of osteoporosis or taking medication interfering with bone metabolism.

Primary and secondary outcome measures: Lateral VFA images and scans of the lumbar spine and proximal femur were obtained using a GE Healthcare Lunar Prodigy densitometer. VFs were defined using a combination of Genant semiquantitative (SQ) approach and morphometry. VFA images were scored for AAC using a validated 24 point scale.

Results: VFA images showed that 179 of the participants (19.7%) had at least one grade 2/3 VF, 81% did not have any detectable AAC whereas the prevalence of significant atherosclerotic burden, defined as AAC score of 5 or higher, was 12%. The group of women with 2/3 VFs had a statistically significant higher AAC score and higher proportion of subjects with extended AAC, and lower weight, height, and lumbar spine and hip BMD and T-scores than those without VFA-identified VFs. Multiple regression analysis showed that the presence of grade 2/3 VFs was significantly associated with age, BMI, history of peripheral fracture, AAC score ≥ 5 and densitometric osteoporosis.

Conclusion: In post-menopausal women, extended AAC is independently associated with prevalent VFs regardless of age, BMI, history of fractures, and BMD.

Keywords: Abdominal aortic calcification; Dual-energy X-ray absorptiometry (DXA); Osteoporosis; Vertebral fracture assessment (VFA); Vertebral fractures; Women.