Systemic markers of microvascular disease and bone mineral density in older adults: The cardiovascular health study

J. I. Barzilay, P. Bůžková, H. A. Fink, J. A. Cauley, J. A. Robbins, P. S. Garimella, D. I. Jalal, K. J. Mukamal

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12 Scopus citations


Summary: Here we report that abnormal brain white matter and, to a lesser extent, albuminuria are associated with reduced bone mineral density in the hip, spine, and total body in men and women. These findings may explain the increased hip fracture risk reported in some studies in association with microvascular disorders. Introduction: Markers of microvascular disease have been individually associated with increased risk of osteoporotic fractures in some studies. Here, we examine whether these markers are associated with reduced bone mineral density (BMD) individually and together. Methods: BMD testing using dual x-ray absorptiometry of the hip, lumbar spine, and total body was performed in 1473 participants from the Cardiovascular Health Study (mean age ~ 78 years): 1215 were assessed for urinary albumin-creatinine ratio, 944 for abnormal white matter disease (AWMD) by brain MRI, and 541 for retinal vascular disease with fundus photographs. Linear regression models were used to evaluate the cross-sectional association of each marker with BMD accounting for potentially confounding factors. Results: AWMD was associated with lower hip, spine, and total body BMD in women (β −3.08 to −4.53; p < 0.01 for all) and lower hip and total body BMD in men (β −2.90 to −4.24; p = 0.01–0.03). Albuminuria was associated with lower hip (β −3.37; p = .05) and total body (β −3.21; p = .02) BMD in men, but not in women. The associations of AWMD and albuminuria with BMD persisted with mutual adjustment and appeared to be additive to each other. Retinal vascular disease was not associated with BMD in men or women. Conclusion: AWMD and, to a lesser extent, albuminuria were independently associated with lower BMD, suggesting that microvascular disease may play a role in the pathogenesis of reduced BMD. These findings need to be confirmed by longitudinal studies.

Original languageEnglish (US)
Pages (from-to)3217-3225
Number of pages9
JournalOsteoporosis International
Issue number11
StatePublished - Nov 1 2016

Bibliographical note

Funding Information:
This research was supported by contracts HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and grant U01HL080295 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by R01AG023629 from the National Institute on Aging (NIA). A full list of principal CHS investigators and institutions can be found at .

Publisher Copyright:
© 2016, International Osteoporosis Foundation and National Osteoporosis Foundation.


  • Albuminuria
  • Bone mineral density
  • Brain white matter disease
  • Osteoporosis
  • Retinal vascular disease


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