Association between vertebral fractures and coronary artery calcification in current and former smokers in the ECLIPSE cohort

• Published in: Osteoporosis international Vol. 31; no. 2; pp. 297 - 305
• Main Authors: van Dort, M. J., Driessen, J. H. M., Geusens, P., Romme, E. A. P. M., Smeenk, F. W. J. M., Rahel, B. M., Eisman, J. A., Wouters, E. F. M., van den Bergh, J. P. W.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.02.2020; Springer Nature B.V
• Subjects: Aged; Calcification; Calcification (ectopic); Chest; Chronic obstructive pulmonary disease; Comorbidity; Coronary artery; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; Coronary Artery Disease - etiology; Coronary vessels; Endocrinology; Female; Fractures; Humans; Lung diseases; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Obstructive lung disease; Original; Original Article; Orthopedics; Osteoporosis; Osteoporosis - epidemiology; Osteoporosis - etiology; Rheumatology; Risk Factors; Smokers; Spinal Fractures - diagnostic imaging; Spinal Fractures - epidemiology; Spinal Fractures - etiology; Spine; Vascular Calcification - diagnostic imaging; Vascular Calcification - epidemiology; Vascular Calcification - etiology; Vertebrae; Coronary artery calcification; Vertebral fracture; Comorbidity; Agatston score; COPD; Smoking
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-019-05218-w

Summary In smokers and former smokers from the ECLIPSE cohort, there is an association between prevalent vertebral fractures (VFs) and coronary artery calcification (CAC). Chest CT scans provide the opportunity to evaluate VFs and CAC, which are potentially important comorbidities, each of which is amenable to effective interventions. Introduction Prevalence of VFs among smokers and patients with chronic obstructive pulmonary disease (COPD) is high, and an association between CAC and osteoporosis has been described. We investigated the associations between VFs and CAC (expressed in Agatston score) in (former) smokers. Methods Current and former smokers from the ECLIPSE study (designed to determine underlying COPD progression mechanisms) were studied. Baseline Agatston score (zero (0), medium (1–400), or high (> 400)), baseline bone attenuation (BA), and prevalent and incident VFs (vertebrae T 1 –L 1 ) were assessed on CT. Results A total of 586 subjects were included (mean age 59.8 ± 8.3; 62.3% men; 70.1% with COPD; 21.0% with prevalent VFs; 196 with zero, 266 with medium, and 124 with high Agatston score). Of these, 23.4% suffered incident VFs within 3 years. In multivariate models, prevalent VFs were associated with medium (1.83 [95% CI 1.01–3.30]) and with high (OR = 3.06 [1.45–6.47]) Agatston score. After adjustment for BA, prevalent VFs were still associated with high (OR = 2.47 [1.13–5.40]), but not significantly with medium Agatston score (OR = 1.57 [0.85–2.88]). Similarly, after adjustment for BA, high (OR = 2.06 [1.02–4.13]) but not medium Agatston score (OR = 1.61 [0.88–2.94]) was associated with prevalent VFs. Agatston score at baseline was not associated with short-term VF incidence. Conclusion In (former) smokers, there was an association between prevalent VFs and Agatston score. Chest CT scans provide the opportunity to also evaluate for VFs and CAC, which are potentially important comorbidities, each of which is amenable to effective interventions.