Table II -.

Summary of epidemiologic studies of BMD and cardiovascular morbidity.

Author	Design	Study	Population	BMD measurement	CVD endpoint	Result	Comment
Farhat et al., 2007	Prospective (average follow-up of 5.4 years)	Health ABC	2,310 participants, 55% women, 42% black, aged 68-80 years	–Areal BMD (aBMD) measures of the hip –Volumetric BMD (vBMD) measures of the spine (integral, trabecular, cortical)	Incident CHD, cerebrovascular disease, or carotid artery disease	–In women: –In men: Spine vBMD measures were inversely associated with incident CVD in white men HR(integral)= 1.39, 95%CI 1.03-1.87; HR(cortical)= 1.38, 95%CI 1.03-1.84), but not in black men	–
Farhat et al., 2006	Cross-sectional	Health ABC	3,075 participants, 51% women, 42% black	–Areal BMD (aBMD) measures of the hip –Volumetric BMD (vBMD) measures of the spine (integral, trabecular, cortical)	Prevalent CVD (CHD, peripheral arterial disease, cerebrovascular disease congestive heart failure)	–In women, for each SD decrease in integral vBMD, or trochanter aBMD, the odds of CVD were significantly increased by 28%, 27%, and 22%, respectively. –In men: spine vBMD measures were inversely associated with CVD in men (OR(integral)= 1.34, 95%CI 1.10-1.63; OR(trabecular)= 1.25, 95%CI 1.02-1.53; OR(cortical)=1.36, 95%CI 1.11-1.65)	–
Tanko et al., 2005	Prospective (4-years follow-up)	MORE Study	2,576 postmenopausal women assigned to the placebo arm of the MORE trial, mean age= 66.5 years.	–Osteoporosis (=having a vertebral fracture or a total hip BMD t-score of -2.5 or less) –Low bone density (having a t-score greater than -2.5 but less than -1.0 without vertebral fractures)	Incidence of fatal and non-fatal cardiovascular events (coronary events and cerebrovascular events)	–Women with osteoporosis had a 3.9-fold increased risk for cardiovascular events, compared to those with low bone mass –Presence of at least 1 vertebral fracture, versus no vertebral fracture, was associated with a 3.0-fold increased risk for cardiovascular events	–Did not exclude prior CVD –53% had osteoporosis, rest had low bone mass –Did not adjust for physical activity
Magnus et al., 2005	Cross-sectional	NHANES III	5,050 African-American, Mexican-American, and Caucasian men and women. Aged 50-79 years	Total hip BMD (DXA)	Myocardial infarction	–Previous MI was associated with low BMD in the total group (OR= 1.28, 95% CI 1.01-1.63) and in men (OR= 1.39, 95% CI= 1.03-1.87). –No association in women	–Associations present only after adjusting for covariates
Marcovitz et al., 2005	Retrospective	Ambulatory adult patients	209 patients, 89% women, 91% white, average age= 67 years	Spine, femur, ultradistal radius, and 1/3 distal radius (DXA)	Angiographicallydetermined coronary artery disease (=50% luminal narrowing in a major artery)	–Osteoporosis was an independent predictor of CAD (OR= 5.6, 95%CI 2.6-12.0)	–Most of patients (75%) were diagnosed with osteoporosis/ osteopenia. –56% had significant CAD. –DEXA and coronary angiogram performed within a 12-month period
Samelson et al., 2004	Prospective (30year follow-up)	The Framingham Study	White, men and women, 47-80 years, (n= 2,059)	Relative metacarpal cortical area (Radiogrammetry)	Incident CHD	–In women, highest MCA quartile was related to a 73% reduced risk of CHD incidence compared to lowest quartile. –No association in men	Adjusted for age, education, BMI, smoking, alcohol, systolic blood pressure, cholesterol, HDL, and diabetes
Jørgensen et al., 2001	Case-control	Norwegian Study	White men and postmenopausal women, age 60 years, n= 260	Femoral neck BMD (DXA)	Acute stroke	–1 SD decrease in BMD was associated with 1.9 fold increase in odds of stroke. –No significant association in men	Adjusted for BMI, alcohol, previous MI, and medication for hypertensive
Mussolino et al., 2003	Prospective	NHANES I	White and black, men and women, 4574 years, n=3402	Phalangeal BMD (RA)	Stroke incidence	Incidence of stroke was not associated with a decrease in BMD in white men, white women, or blacks	Adjusted for age, smoking, alcohol consumption, history of diabetes, history of heart disease, education, BMI, physical activity, and blood pressure medications
Laroche et al., 1994	Cross-sectional		18 men	BMC of legs (DXA)	Symptomatic peripheral arterial disease	BMC of the more severely affected leg was lower significantly lower than BMD of the less affected leg	–
Browner et al., 1993	Prospective (1.98-years follow-up)	SOF	White, postmenopausal women, 65 years and older, n= 4024	Calcaneal BMD (SPA)	Incident stroke	–1 SD decrease in calcaneal BMD was associated with 1.31 fold increase in stroke	Adjusted for age, follow-up time, diabetes, systolic blood pressure, alcohol, smoking, HRT use, cognitive ability, grip strength, and functional ability