Tzyy‑Ling Chuanga,b, Mei‑Hua Chuangc,d, Malcolm Kooe, Chun‑Hung Linf, Yuh‑Feng Wanga,b,g*
aDepartment of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, bSchool of Medicine, Tzu Chi University, Hualien, Taiwan, cFaculty of Pharmacy, National Yang‑Ming University, Taipei, Taiwan, dDepartment of Pharmacology, School of Medicine, Tzu Chi University, Hualien, Taiwan, eGraduate Institute of Long‑Term Care, Tzu Chi University of Science and Technology, Hualien, Taiwan, fDepartment of General Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, gCenter of Preventive Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation
Abstract
Traditionally, osteoporosis and cardiovascular disease (CVD) are considered as separate chronic diseases. Increasing evidence now links osteoporosis with hypertension, abnormal lipid metabolism, atherosclerosis, vascular calcification (VC), and congestive heart failure. VC coexists with bone loss, and aortic calcification is a strong predictor of low bone mineral density (BMD) and fragility fractures. The same holds true for coronary artery calcification (CAC): the lower the BMD, the higher the CAC. Trabecular bone score (TBS) iNsight software can analyze the existing BMD database to obtain the bony microstructure score (TBS). Many TBS‑related studies include fracture risk, normal aging, diabetes, potential genes, obesity, and asthma severity prediction. The inverse relationship of TBS to VC may provide insight into bone–vascular interactions in chronic kidney disease. A higher TBS has been associated with moderate, but not high, CAC. One explanation is that bone microstructural remodeling becomes more active during early coronary calcification. Increased risk of 10‑year likelihood of hip fracture and major osteoporotic fracture as estimated by the fracture risk assessment tool FRAX® is significantly and independently associated with more severe CAC scores. Dual‑energy X‑ray absorptiometry and FRAX® can be used to predict fracture risk and CAC scores, identifying patients who may benefit from early intervention. This review will discuss the relationship and possible mechanism of BMD, TBS, and FRAX® with CVD and VC or CAC.
Keywords: Bone mineral density, Cardiovascular disease, Coronary artery calcification, Trabecular bone score
