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Relationship Between Bone Cross-Sectional Area and Indices of Peripheral Artery Disease

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Abstract

Most studies on the relationship between bone mineral density and atherosclerosis have used dual-energy X-ray absorptiometry, but this method is relatively insensitive to bone geometry. The aim of this study was to investigate the relationship between bone area and indices of carotid and peripheral atherosclerosis. We studied 841 persons aged 65 years or older (women = 444, mean age 73.8 years; men = 397, mean age = 75.3 years) enrolled in the InCHIANTI study and free from active malignancies, chronic use of bisphosphonates or steroids, and estrogen replacement therapy. The tibial cortical and total cross-sectional area (CSA) were measured by peripheral quantitative computed tomography and their ratio was calculated (cortical/total cross-sectional area ratio, cCSA/tCSA); carotid plaques were screened by echography, and peripheral artery disease (PAD) was defined as an ankle/brachial index <0.9 or presence of intermittent claudication. No association between cCSA/tCSA and atherosclerosis was observed in men. In women, lower cCSA/tCSA was associated with both carotid plaques [odds ratio (OR) for lowest vs. best quartile = 2.09, 95 % confidence interval (CI) 1.2–3.68] and PAD (OR = 3.43, 95 % CI 1.58–8.12). After correction for potential confounders (age since menopause, body mass index, Parathyroid hormone, vitamin D, leptin, DHEA-S, testosterone, physical activity, chronic obstructive pulmonary disease, and reduced renal function), the association was not confirmed. According to partial logistic regression, the carotid plaque–cCSA/tCSA association, but not the PAD–cCSA/tCSA association, was mostly dependent on years since menopause. In women the association between osteoporosis and carotid plaques likely reflects hormonal deprivation, whereas that between osteoporosis and PAD seems multifactorial in origin.

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Abbreviations

BMD:

Bone mineral density

DEXA:

Dual-energy X-ray absorptiometry

PAD:

Peripheral artery disease

pQCT:

Peripheral quantitative computed tomography

ABI:

Ankle-brachial index

cCSA/tCSA:

Cortical/total cross-sectional area ratio

PTH:

Parathyroid hormone

DHEA-S:

Dehydroepiandrosterone-sulfate

IL-6:

Interleukin 6

CRP:

C-reactive protein

EPIC:

EPidemiological Investigation into Cancer

HRT:

hormone replacement therapy

PPI:

Proton pump inhibitors

SSRI:

Selective serotonin re-uptake inhibitors

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Authors and Affiliations

  1. Area of Geriatrics, Campus Biomedico University and Teaching Hospital, Via Alvaro del Portillo 200, 00128, Rome, Italy

    Claudio Pedone, Simone Scarlata & Raffaele Antonelli Incalzi

  2. Division of Endocrinology, Campus Bio-Medico University and Teaching Hospital, Rome, Italy

    Nicola Napoli

  3. Geriatric Unit and Laboratory of Movement Analysis, Geriatric and Rehabilitation Department, University Hospital of Parma, Parma, Italy

    Fulvio Lauretani

  4. Geriatric Rehabilitation Unit, Azienda Sanitaria Firenze, Florence, Italy

    Stefania Bandinelli

  5. Longitudinal Study Section, Clinical Research Branch, National Institute of Aging, Baltimore, MD, USA

    Luigi Ferrucci

  6. San Raffaele–Cittadella della Carità Foundation, Taranto, Italy

    Raffaele Antonelli Incalzi

Authors
  1. Claudio Pedone
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  2. Simone Scarlata
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  3. Nicola Napoli
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  4. Fulvio Lauretani
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  5. Stefania Bandinelli
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  6. Luigi Ferrucci
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  7. Raffaele Antonelli Incalzi
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Correspondence to Claudio Pedone.

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The authors have stated that they have no conflict of interest.

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Pedone, C., Scarlata, S., Napoli, N. et al. Relationship Between Bone Cross-Sectional Area and Indices of Peripheral Artery Disease. Calcif Tissue Int 93, 508–516 (2013). https://doi.org/10.1007/s00223-013-9782-y

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  • DOI: https://doi.org/10.1007/s00223-013-9782-y

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