Aortic calcification and the risk of osteoporosis and fractures.
Abstract
We investigated the relation between computed tomography measures of aortic calcification and values for bone density and the number of fragility fractures in 2348 healthy, postmenopausal women. To determine whether increases in vascular calcification and bone loss progress in parallel, baseline values were compared with measurements obtained 9 months to 8 yr later in a subgroup of 228 women. Of the 2348 subjects studied, 70% had osteoporosis, 30% had at least one vertebral fracture, and 9% had at least one hip fracture. Aortic calcifications were inversely related to bone density and directly related to fractures. After adjusting for age and potential confounders, measures for aortic calcification predicted 26.1% of the variance in bone density (P < 0.001). Compared with women without calcification, the odds ratios for vertebral and hip fractures in those with calcification were estimated to be 4.8 (95% confidence interval, 3.6-6.5) and 2.9 (95% confidence interval, 1.8-4.8), respectively. The subgroup analysis of 228 women longitudinally studied showed that the percentage of yearly increase in aortic calcification accounted for 47% of the variance in the percentage rate of bone loss (P < 0.001). Moreover, a strong graded association was observed between the progression of vascular calcification and bone loss for each quartile. Women in the highest quartile for gains in aortic calcification had four times greater yearly bone loss (5.3 vs.1.3% yearly; P < 0.001) than women of similar age in the lowest quartile. Smaller, but highly significant differences were also found between all other quartiles. We conclude that aortic calcifications are a strong predictor for low bone density and fragility fractures.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In postmenopausal women, aortic calcifications are inversely related to bone density and positively associated with fractures.
“Observational studies in postmenopausal women showed that aortic calcifications were inversely related to bone density and positively associated with fractures (152).”
From Receptor Activator of Nuclear Factor κB Ligand and Osteoprotegerin Regulation of Bone Remodeling in Health and Disease (2008) · cites this paper as [152]
Cites
Quantification of coronary artery calcium using ultrafast computed tomography
Agatston, A. S., Janowitz, W. R., Hildner, F. J., Zusmer, N. R., Viamonte, M., & Detrano, R. (1990) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(90)90282-t · Cited by 7,786 · see citing works
Multivariate Statistical Methods
(2008) · Springer eBooks · doi:10.1007/978-1-4020-5614-7_2263 · Cited by 5,584 · see citing works
Introduction to Statistical Analysis.
Latshaw, V. V., Dixon, W. J., & Massey, F. J. (1957) · American Mathematical Monthly · doi:10.2307/2309989 · Cited by 5,083 · see citing works
Reproducibility and validity of a semiquantitative food frequency questionnaire
WILLETT, W. C., SAMPSON, L., STAMPFER, M. J., ROSNER, B., BAIN, C., WITSCHI, J., HENNEKENS, C. H., & SPEIZER, F. E. (1985) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a114086 · Cited by 4,274 · see citing works
Professor Kanis, J. A., Melton, L. J., Christiansen, C., Johnston, C. C., & Khaltaev, N. (1994) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.5650090802 · Cited by 3,849 · see citing works
Stimulation of Bone Formation in Vitro and in Rodents by Statins
Mundy, G. R., Garrett, R., Harris, S., Chan, J., Chen, D., Rossini, G., Boyce, B. F., Zhao, M., & Gutierrez, G. (1999) · Science · doi:10.1126/science.286.5446.1946 · Cited by 1,776 · see citing works
Bone morphogenetic protein expression in human atherosclerotic lesions.
Boström, K. I., Watson, K. E., Horn, S. E. V., Wortham, C., Herman, I. M., & Demer, L. L. (1993) · Journal of Clinical Investigation · doi:10.1172/jci116391 · Cited by 1,020 · see citing works
Analysis of Repeated Measures.
ELASHOFF, J. D., Crowder, M. J., & Hand, D. J. (1991) · Journal of the American Statistical Association · doi:10.2307/2290432 · Cited by 940 · see citing works
Noninvasive assessment of bone mineral and structure: State of the art
Genant, H. K., Engelke, K., Fuerst, T. P., Glüer, C., Grampp, S., Harris, S. T., Jergas, M. D., Lang, T., Lü, Y., Majumdar, S., et al. (1996) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.5650110602 · Cited by 939 · see citing works
High expression of genes for calcification-regulating proteins in human atherosclerotic plaques.
Shanahan, C. M., Cary, N. R. B., Metcalfe, J. C., & Weissberg, P. L. (1994) · Journal of Clinical Investigation · doi:10.1172/jci117246 · Cited by 610 · see citing works
Kiel, D. P., Kauppila, L. I., Cupples, L. A., et al. (2001) · Calcified Tissue International · doi:10.1007/bf02390833 · Cited by 485 · see citing works
HMG-CoA Reductase Inhibitors and the Risk of Fractures
Meier, C. R. (2000) · JAMA · doi:10.1001/jama.283.24.3205 · Cited by 447 · see citing works
Non-trauma mortality in elderly women with low bone mineral density
Browner, W. S., Seeley, D. G., Cummings, S. R., & VOGT, T. M. (1991) · The Lancet · doi:10.1016/0140-6736(91)90489-c · Cited by 412 · see citing works
The association between low bone mass at the menopause and cardiovascular mortality
von der Recke, P., Hansen, M. A., & Hassager, C. (1999) · The American Journal of Medicine · doi:10.1016/s0002-9343(99)00028-5 · Cited by 403 · see citing works
Progression of Aortic Calcification Is Associated With Metacarpal Bone Loss During Menopause
Hak, A. E., Pols, H. A. P., van Hemert, A. M., Albert Hofman, D., & Witteman, J. C. M. (2000) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.20.8.1926 · Cited by 373 · see citing works
Oral statins and increased bone-mineral density in postmenopausal women
Edwards, C., Hart, D. J., & Spector, T. D. (2000) · The Lancet · doi:10.1016/s0140-6736(00)02408-9 · Cited by 328 · see citing works
Atherogenic High-Fat Diet Reduces Bone Mineralization in Mice
Parhami, F., Tintut, Y., Beamer, W. G., Gharavi, N. M., Goodman, W. G., & Demer, L. L. (2001) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.2001.16.1.182 · Cited by 302 · see citing works
Osteoporosis and Coronary Atherosclerosis in Asymptomatic Postmenopausal Women
Barengolts, E. I., Berman, M., Kukreja, S. C., et al. (1998) · Calcified Tissue International · doi:10.1007/s002239900419 · Cited by 271 · see citing works
Rate of Bone Loss Is Associated with Mortality in Older Women: A Prospective Study
Kado, D. M., Browner, W. S., BLACKWELL, T. L., Gore, L. R., & Cummings, S. R. (2000) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.2000.15.10.1974 · Cited by 258 · see citing works
The Supplement on Aging to the 1984 National Health Interview Survey.
Fitti, J. E., & Kovar, M. G. (1987) · PubMed · Cited by 254 · see citing works
Aortic calcified plaques and cardiovascular disease (the Framingham study)
Witteman, J. C. M., Kannel, W. B., Wolf, P. A., Grobbee, D. E., Albert Hofman, D., D’Agostino, R. B., & Cobb, J. L. (1990) · The American Journal of Cardiology · doi:10.1016/0002-9149(90)90505-u · Cited by 237 · see citing works
Rumberger, J. A., Schwartz, R. S., Simons, D. B., Sheedy, P. F., Edwards, W. D., & Fitzpatrick, L. A. (1994) · The American Journal of Cardiology · doi:10.1016/0002-9149(94)90176-7 · Cited by 215 · see citing works
Osteoporosis and calcification of the aorta
Frye, M. A., Melton, L. J., Bryant, S. C., et al. (1992) · Bone and Mineral · doi:10.1016/0169-6009(92)90925-4 · Cited by 207 · see citing works
Chemical and physicochemical studies on the mineral deposits of the human atherosclerotic aorta
Schmid, K., McSharry, W. O., Pameijer, C. H., et al. (1980) · Atherosclerosis · doi:10.1016/0021-9150(80)90005-2 · Cited by 189 · see citing works
Bone Changes and Carotid Atherosclerosis in Postmenopausal Women
Uyama, O., Yoshimoto, Y., Yamamoto, Y., et al. (1997) · Stroke · doi:10.1161/01.str.28.9.1730 · Cited by 177 · see citing works
Banks, L. M., Lees, B., MacSweeney, J. E., et al. (1994) · European Journal of Clinical Investigation · doi:10.1111/j.1365-2362.1994.tb02024.x · Cited by 165 · see citing works
Gilsanz, V., Loro, M. L., Roe, T., Sayre, J. W., Gilsanz, R., & Schulz, E. (1995) · Journal of Clinical Investigation · doi:10.1172/jci117925 · Cited by 159 · see citing works
Self-citationDeterminants of the rate of bone loss in normal postmenopausal women
Reid, I. R., Ames, R. W., Evans, M. C., Sharpe, S. J., & Gamble, G. D. (1994) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.79.4.7962303 · Cited by 156 · see citing works
The effect of overlying calcification on lumbar bone densitometry
Drinka, P. J., DeSmet, A. A., Bauwens, S. F., et al. (1992) · Calcified Tissue International · doi:10.1007/bf00582163 · Cited by 150 · see citing works
Jie, K.-S. G., Bots, M. L., Vermeer, C., et al. (1996) · Calcified Tissue International · doi:10.1007/s002239900139 · Cited by 142 · see citing works
Bone Mineral Density and Aortic Calcification: The Study of Osteoporotic Fractures
Vogt, M. T., Valentin, R. S., Forrest, K. Y. Z., et al. (1997) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1997.tb04498.x · Cited by 141 · see citing works
Calcification of the aorta and osteoporosis. A roentgenographic study
Boukhris, R. (1972) · JAMA · doi:10.1001/jama.219.10.1307 · Cited by 129 · see citing works
Mechanism of calcification in atherosclerosis
Demer, L. L., Watson, K. E., & Boström, K. I. (1994) · Trends in Cardiovascular Medicine · doi:10.1016/1050-1738(94)90025-6 · Cited by 116 · see citing works
A study of the correlation between roentgenographic and post-mortem calcification of the aorta
Hyman, J., & Epstein, F. H. (1954) · American Heart Journal · doi:10.1016/0002-8703(54)90119-2 · Cited by 95 · see citing works
Laroche, M., Pouillès, J. M., Ribot, C. A., Bendayan, P., Bernard, J.-C., Boccalon, H., & Mazières, B. (1994) · Clinical Rheumatology · doi:10.1007/bf02243003 · Cited by 90 · see citing works
Osteoporosis of Lumbar Vertebrae and Calcification of Abdominal Aorta in Women Living in Durban
Dent, C. E., Engelbrecht, H. E., & Godfrey, R. C. (1968) · BMJ · doi:10.1136/bmj.4.5623.76 · Cited by 86 · see citing works
The Relation between Osteoporosis and Aortic Calcification
Anderson, J., Barnett, E., & Nordin, B. E. C. (1964) · British Journal of Radiology · doi:10.1259/0007-1285-37-444-910 · Cited by 61 · see citing works
Characterization of a Gla-containing protein from calcified human atherosclerotic plaques.
Gijsbers, B. L. M. G., van Haarlem, L. J. M., Soute, B. A. M., et al. (1990) · Arteriosclerosis An Official Journal of the American Heart Association Inc · doi:10.1161/01.atv.10.6.991 · Cited by 52 · see citing works
Epidemiology of Fractures and Assessment of Fracture Risk
Black, D. M., & Cooper, C. C. (2000) · Clinics in Laboratory Medicine · doi:10.1016/s0272-2712(18)30046-5 · Cited by 52 · see citing works
Ouchi, Y., Akishita, M., SOUZA, A. C. D., et al. (1993) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1993.tb38743.x · Cited by 49 · see citing works
Femoral head necrosis and osteopenia in stroke-prone spontaneously hypertensive rats (SHRSPs)
Naito, S., Ito, M., Sekine, I., et al. (1993) · Bone · doi:10.1016/8756-3282(93)90206-p · Cited by 36 · see citing works
Fujita, T., OKAMOTO, Y., SAKAGAMI, Y., et al. (1984) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1984.tb05852.x · Cited by 36 · see citing works
Orimo, H., Terashita, K., Nakamura, T., et al. (1985) · Journal of Nutritional Science and Vitaminology · doi:10.3177/jnsv.31.supplement_s33 · Cited by 10 · see citing works
Relation between osteoporosis and aorta calcification and its physiological explanation
Driessens, F. C. M., Steidl, L., Verbeeck, R. M. H., et al. (1991) · Ghent University Academic Bibliography (Ghent University) · Cited by 7 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Kearns, A. E., Khosla, S., & Kostenuik, P. J. (2008) · Endocrine Reviews · doi:10.1210/er.2007-0014 · Cited by 824 · see citing works
Manolagas, S. C., & Parfitt, A. M. (2010) · Trends in Endocrinology & Metabolism · doi:10.1016/j.tem.2010.01.010 · Cited by 404 · see citing works
Role of the RANK/RANKL/OPG and Wnt/β-Catenin Systems in CKD Bone and Cardiovascular Disorders
Workgroup, O. B. O. T. E. R. O. (., Carrillo-López, N., Martínez-Arias, L., Fernández-Villabrille, S., Ruiz-Torres, M. P., Dusso, A., Cannata-Andía, J. B., Naves-Díaz, M., & Panizo, S. (2021) · Calcified Tissue International · doi:10.1007/s00223-020-00803-2 · Cited by 91 · see citing works
- Authors
- Schulz, E., Arfai, K., Liu, X., Sayre, J., & Gilsanz, V.
- Affiliations
- University of Southern California (US)
- University of California, Los Angeles (US)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2004-09
- Volume
- 89
- Issue
- 9
- Pages
- 4246-4253
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2025994623
- Cited by
- 429
- References
- 44
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 13 · 2023: 8 · 2022: 9 · 2021: 18 · 2020: 22 · 2019: 16 · 2018: 17 · 2017: 17 · 2016: 20 · 2015: 25 · 2014: 26 · 2013: 34 · 2012: 26
- FWCI
- 19.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Loma Linda University
- National Institutes of Health (2r01lm006270-04)
- U.S. National Library of Medicine (R01 LM06270-05)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (N01-HD-1-3333-01)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Dermatological and Skeletal Disorders
- Keywords
- aortic calcification, vascular calcification, osteoporosis, bone mineral density, fragility fractures, vertebral fractures, hip fracture, postmenopausal women, bone loss, fracture risk prediction
- MeSH terms
- Aged, Aged, 80 and over, Aging, Aortic Diseases, Calcinosis, Cross-Sectional Studies, Female, Humans, Longitudinal Studies, Middle Aged, Osteoporosis, Risk, Bone Density, Prevalence, Fractures, Bone
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
