Association between atherosclerosis and bone loss in the Korean population: results from a large community-based cohort study

Abstract

Many clinicians have demonstrated the frequent presence of atherosclerosis in osteoporosis patients. Although the number of proposals for the co-pathways related to atherosclerosis and osteoporosis are on the rise, no studies have evaluated the relationship between changes in carotid intima-media thickness (CIMT) and changes in bone density, in a longitudinal cohort. We aimed to evaluate the association between changes in CIMT and changes in bone mineral density (BMD) by using dual-energy X-ray absorptiometry (DXA). Data of 3,403 participants who underwent both CIMT measurement and DXA were performed in 2011-2012 and 2013-2014 were analyzed, as a part of the Ansung cohort study. Carotid atherosclerosis was classified according to the CIMT quartiles, into the group with a CIMT of 0.1 cm or higher and the group with a CIMT lower than 0.1 cm. Based on changes in the CIMT, patients were classified into the accelerating progressor group and non-progressor group, by mean + 1 standard deviation (0.0915 cm/2 years), and the new plaque group or disappeared plaque group, by changes in the plaque status. By various carotid atherosclerosis criteria, adipokine levels were additionally compared. As the CIMT quartiles increased, the total hip and femur neck BMD, in men, and the lumbar, total hip and femur neck BMD, in women, decreased. The risk of the CIMT being greater than 0.1 cm increased as the lumbar BMD decreased by 5%, in a longitudinal cohort analysis, with an odds ratio of 1.627 (95% confidence interval, 1.111-2.382) after adjusting for age, hypertension, diabetes, dyslipidemia and postmenopausal duration. Significant decreases were observed in the femur neck BMD in the accelerating progressor group compared to the non-progressor group (P < 0.001)

this significance persisted after adjusting for age (0.012±0.047 mm vs. -0.008±0.050 mm, P < 0.001). On comparing between the new plaque and disappeared plaque groups, the trabecular bone score (TBS) values were significantly lower in the new plaque group than in the disappeared plaque group, at the 6-year follow-up, even after adjusting for age, sex, systolic blood pressure, levels of glycated hemoglobin, low-density lipoprotein cholesterol and serum creatinine, smoking status, and alcohol status. As for the biomarkers, the adiponectin level was lower in the new plaque group than in the disappeared plaque group. In contrast, the adiponectin levels were higher in those in the group with a CIMT of 0.1 cm or more than in the group with a CIMT lower than 0.1 cm. For the postmenopausal women, at the 4-year follow-up, the risk of the CIMT being greater than 0.1 cm increased as the lumbar BMD decreased by 5%. The accelerating progressor group was associated with a much lower femur neck BMD than the non-progressor group, after adjusting for age. The new carotid plaque group had a much lower TBS than the disappeared plaque group. However, in terms of the adipokine levels, we did not obtain consistent results. In conclusion, in this large prospective Korean community-based cohort, we found that, in those with a CIMT higher than 0.1 cm (pathologic CIMT) or those in the accelerating progressor group or new plaque group, screening for bone health could be helpful.