New York, NY - Low bone-mineral density (BMD) is an independent predictor of angiographically proven coronary artery disease (CAD), a new study shows [1]. In a paper online August 22, 2005 in the American Journal of Cardiology, Dr Pamela A Marcovitz (Detroit Medical Center, MI) and colleagues report that people—predominantly women—with osteoporosis had a sixfold higher risk of CAD than those without osteoporosis.

In an interview with heartwire, senior author Dr Christine Z Dickinson (William Beaumont Hospital, Royal Oak, MI) explained that while other research has shown an association between low bone density and cardiovascular events, this paper is the first to show a relationship between bone-density scores and angiographic indices of atherosclerotic disease.

Marcovitz, Dickinson, and colleagues assessed atherosclerotic narrowing and BMD in 209 patients (183 of whom were female) referred for both dual-energy x-ray absorptiometry (DEXA) and coronary angiography within a 12-month period. They report that in both univariate and multivariate analyses, low DEXA scores (indicating osteopenia or osteoporosis) were predictors of CAD, along with the usual suspects: hypertension, smoking, diabetes, high fasting glucose, family history, etc. Overall, however, the odds ratio for predicting angiographic CAD was highest for osteoporosis, followed by hypertension, family history, and serum glucose level. The number of diseased arteries, defined as >50% stenosis, was also higher in patients with low bone density.

Marcovitz and colleagues are planning studies to look prospectively at the link between BMD and angiographically proven disease. To heartwire, Dickinson commented that further research is also necessary to look for mechanistic links between the two conditions.

"There have been some thoughts that these might be linked by lipid metabolism; however, a clear cause and effect has not been established. There really is no clear understanding at present as to a common etiology," Dickinson said.

Dickinson emphasized that subsequent studies will be needed to confirm the link, but, if substantiated, the finding could be important to managing patients found to have low bone density.

"If low bone-mineral density can be established as a true risk factor, it could be used like any other kind of risk factor, such as diabetes, metabolic syndrome, that sort of thing, to better understand risk and outcomes," Dickinson said.