Yeonyee E. Yoon, MD, PhD Associate Professor Division of Cardiology, Cardiovascular Center  Seoul National University Bundang Hospital South Korea

Low Bone Mineral Density Linked to Heart Disease in Women Interview with:

Yeonyee E. Yoon, MD, PhD Associate Professor Division of Cardiology, Cardiovascular Center  Seoul National University Bundang Hospital South Korea

Dr. Yoon

Yeonyee E. Yoon, MD, PhD
Associate Professor
Division of Cardiology, Cardiovascular Center
Seoul National University Bundang Hospital
South Korea What is the background for this study?

Response: Although atherosclerotic cardiovascular disease (ASCVD) has been traditionally considered to affect men predominantly, it is nearly common in women. ASCVD is the leading cause of death in both men and women globally, and the population-adjusted risk of ASCVD mortality in women is significantly greater than that in men. Nevertheless, the current focus on the 10-year ASCVD risk estimated by a risk-scoring algorithm such as the Pooled Cohort Equation has shown unsatisfactory accuracy in women. Therefore, new strategies beyond the conventional risk stratification algorithm are needed to improve identification for women at high risk for ASCVD.

ASCVD and osteoporosis are major age-related diseases contributing to significant morbidity and mortality in women, and previous epidemiologic studies have suggested a potential association between these diseases. Given that millions of women are screened for osteoporosis using dual-energy X-ray absorptiometry (DXA), potential associations between low bone mineral density (BMD) and ASCVD in women would provide an opportunity to improve the risk stratification of women without any additional costs. Therefore, we aimed to investigate whether the evaluation of BMD provides independent and incremental prognostic values for ASCVD prediction in women. What are the main findings?

Response: In this retrospective observational study comprising 12,681 women aged 50 years and older, we found that lower BMD was independently associated with higher risk for ASCVD events of ASCVD death, nonfatal myocardial infarction, and nonfatal ischemic stroke. The results also demonstrated improved discrimination for ASCVD events by adding BMD over conventional risk factors (age, body mass index, hypertension, type 2 diabetes, hyperlipidemia, current smoking, and previous fracture) or 10-year ASCVD risk by Pooled Cohort Equation. What should readers take away from your report?

Response: Although a potential association between osteoporosis and ASCVD has been proposed, the prognostic value of BMD in predicting future ASCVD has not been well evaluated. In the present study, we found that low BMD has independent and incremental value in predicting future ASCVD in women. Considering that DXA is widely used to screen for osteopenia and osteoporosis in asymptomatic women, the present study results suggest an opportunity to screen women at high risk of ASCVD in a manner that is cost-effective, efficient, and safe without additional radiation exposure. Moreover, given that the risk for ASCVD could even be further stratified according to BMD in a subgroup of relatively young women with no risk factor, this study results support a potential role of BMD in identifying apparently healthy women at increased risk of future ASCVD events. What recommendations do you have for future research as a result of this work?

Response: To our knowledge, the present study is the largest longitudinal study evaluating the association between BMD and risk for ASCVD. Because of its longitudinal design, we were able to evaluate whether refining the risk stratification by adding the BMD would improve the discrimination for future ASCVD. Nevertheless, the study results should be interpreted in the context of the limitation inherent to its retrospective study design. Therefore, prospective studies are required to confirm the independent association between low BMD and risk for ASCVD. Furthermore, before the widespread utilization of BMD to facilitate personalized decision-making, randomized clinical trials of an integrated screening and targeted prevention strategy are needed. Additionally, further evaluation to determine the degree to which BMD refines the risk assessment compared to that with more direct imaging test of the cardiovascular system (i.e., CAC scan, carotid US) or to that with novel risk markers (i.e., hsCRP, lipoprotein(a)) would be valuable. Is there anything else you would like to add?

Response: The significant association between BMD and higher risk of ASCVD provides an opportunity for large-scale ASCVD risk assessment in women without additional cost and radiation exposure. Further studies are warranted to determine whether the evaluation of BMD translates into long-term clinical benefits in women.

The authors declare no conflict of interest.


Park JYoon YEKim KM, et al
Prognostic value of lower bone mineral density in predicting adverse cardiovascular disease in Asian women


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Last Updated on May 12, 2021 by Marie Benz MD FAAD