Bone Mineral Density as a Predictor of Cardiovascular Disease in Women: A Real-World Retrospective Study

Abstract

Background: Atherosclerotic cardiovascular disease (ASCVD) in women remains understudied, under-diagnosed, and under-treated. Traditional risk factors affect men’s and women’s hearts differently. However, the current risk stratification tools do not consider such sexspecific factors. We aimed to investigate the utility of bone mineral density (BMD) with dual-energy X-ray absorptiometry (DXA) scoring as a predictor of ASCVD in women. Methods: Data of 1,995 patients who underwent DXA scanning from 2012 to 2014 at multiple centers within our health system were collected through a chart review and using the SlicerDicer tool of Epic electronic medical records (EMR) to identify comorbidities and outcomes. Age, sex, race, history of hypertension (HTN), hyperlipidemia (HLD), diabetes mellitus (DM), body mass index (BMI), and smoking status were noted. The primary outcome was the composite of ASCVD events (stroke, myocardial infarction (MI) and cardiac death). Osteoporosis was defined as a T score of < 0.0001). Low BMD in each site, the right femur, left femur, and hip is associated with an increased risk of ASCVD events (OR 6.50 (3.637-11.608), P < 0.0001; OR 5.07 (3.166 8.108), P < 0.000; OR 3.36 (2.127-5.312), P < 0.0001, respectively). Osteoporosis is independently linked to a 4.25-fold rise in MI incidence and a 3.64-fold rise in stroke. Osteopenia was not associated with ASCVD events (OR 1.29 (0.754-2.204), P = 0.35416). Conclusions: BMD measurement with DXA scan could stratify and predict the risk of ASCVD events in women, with no additional economic strain on healthcare. Further wide-scale studies are needed to utilize this potentially promising predictor and a commonly used test.