E-Poster Presentation ESA-SRB-ANZBMS 2021

Abdominal aortic calcification, bone mineral density and fractures: a systematic review and meta-analysis of observational studies (#759)

Alexander J Rodriguez 1 , Abadi Kahsu Gebre 2 3 , Joshua Lewis 3 , Kevin Leow 4 , Pawel Szulc 5 , David Scott 6 , Peter R Ebeling 1 , Marc Sim 3 , Germaine Wong 7 , Wai H Lim 8 , John T Schousboe 9 , Douglas P Kiel 10 , Richard L Prince 11
  1. Bone and Muscle Research Group, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
  2. School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
  3. Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
  4. Medical School, University of Western Australia, Perth, Western Australia, Australia
  5. INSERM UMR 1033, University of Lyon, Lyon, France
  6. Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
  7. Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
  8. Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
  9. Park Nicollet Osteoporosis Center and Health Partners Institute, University of Minnesota, Minneapolis, Minnesota, USA
  10. Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  11. Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

Introduction: Abdominal aortic calcification (AAC) has been associated with poorer bone health and increased fracture risk in varied clinical settings, often in small studies with inconsistent findings. We aimed to synthesise observational studies on the association of AAC with bone mineral density (BMD) and fractures in a systematic review and meta-analysis.

Methods: Articles that reported on associations of AAC with BMD and/or fracture were retrieved from online databases from inception to August 2020. AAC was categorised as any/advanced AAC versus low/no AAC (reference group). The relationships between AAC and BMD at skeletal sites were determined by standardised mean difference [SMD] with 95% confidence intervals [CI]. To determine the association between AAC and risk and risk of any fracture, relative risk [RR] with 95%CI was calculated. Random effects models were applied. 

Results: 79 articles (40 providing data for meta-analysis) were included from 2173 articles screened. Moderate quality evidence suggests BMD is lower at the total hip [SMD: -1.05, 95%CI (-1.47 to -0.63); I2 =94%; n=20277], femoral neck [SMD: -0.25 (-0.46 to -0.04); 99%; n=6981] and lumbar spine [SMD: -0.67 (-1.21 to -0.12); 99%; n=17260] in individuals with any/advanced AAC. Moderate quality evidence suggests fractures were more prevalent in individuals with any/advanced AAC [n=3515/14894 versus 2646/14730 (low/no AAC); RR: 1.66 (1.43 to 1.93); 90%]. In prospective studies, any/advanced AAC increased the risk of incident fractures [n=1197/6797 versus 1635/10113; RR 1.40 (1.22 to 1.61); 63%] with lower heterogeneity than seen for prevalent fracture. Findings were similar according to study location and imaging modality, but effects were more pronounced in older women.
Conclusion Moderate quality evidence supports the association of AAC with lower BMD and increased fracture risk. This suggests severe AAC is a risk factor for skeletal fragility and could be combined with BMD to enhance fracture risk prediction.