title: Bone health and coronary artery calcification: The Rotterdam Study.
abstract: OBJECTIVE
  Vascular calcification has been associated inconsistently to low bone mineral density and fractures. The aims of the present study were to investigate the associations between coronary artery calcification (CAC) and BMD change, BMD and fracture risk in elderly subjects of the population-based Rotterdam Study.
  
  
  METHODS
  BMD was assessed through dual-energy X-ray absorptiometry and CAC through Electron-Beam Computed Tomography in 582 men and 694 women. We investigated the associations between BMD change (6.4 years follow-up) and CAC at follow-up and between BMD and CAC (measured simultaneously). In sensitivity analyses we stratified analyses for estradiol levels in women. The association between CAC and fracture risk (9 years follow-up) was tested through competing-risks models. Models were sex-stratified and adjusted for age, body mass index, smoking, bisphosphonate use and age at menopause.
  
  
  RESULTS
  There was no association between BMD change and CAC in men. In women, each 1% increase in annual BMD loss was significantly associated with higher follow-up CAC [β = 0.22 (0.06-0.38), p=0.006; prevalence ratio: 4%]. Stratified analyses showed significant associations between BMD loss and follow-up CAC only in women with lower estradiol levels. We found no association between CAC and fracture risk and no association between BMD and CAC cross-sectionally.
  
  
  CONCLUSIONS
  BMD loss was associated with higher follow-up CAC in women, which might be related to low estrogen levels. No association between CAC and BMD or fracture risk was found. Further studies are required to elucidate the mechanisms that might underlie the association between BMD change and coronary calcification in women.
authors.affiliation: Department of Internal Medicine, Erasmus MC, 3000 CA Rotterdam, The Netherlands.
authors.forename: Natalia
authors.initials: N
authors.lastname: Campos-Obando
authors.affiliation: Department of Epidemiology, Erasmus MC, 3000 CA Rotterdam, The Netherlands.
authors.forename: Maryam
authors.initials: M
authors.lastname: Kavousi
authors.affiliation: Department of Internal Medicine, Erasmus MC, 3000 CA Rotterdam, The Netherlands.
authors.forename: Jeanine E
authors.initials: JE
authors.lastname: Roeters van Lennep
authors.affiliation: Department of Internal Medicine, Erasmus MC, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, 3000 CA Rotterdam, The Netherlands; Netherlands Genomics Initiative-Sponsored Netherlands Consortium for Healthy Ageing (NCHA), 2300 RC Leiden, The Netherlands.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rivadeneira
authors.affiliation: Department of Epidemiology, Erasmus MC, 3000 CA Rotterdam, The Netherlands; Netherlands Genomics Initiative-Sponsored Netherlands Consortium for Healthy Ageing (NCHA), 2300 RC Leiden, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: Department of Internal Medicine, Erasmus MC, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, 3000 CA Rotterdam, The Netherlands; Netherlands Genomics Initiative-Sponsored Netherlands Consortium for Healthy Ageing (NCHA), 2300 RC Leiden, The Netherlands.
authors.forename: André G
authors.initials: AG
authors.lastname: Uitterlinden
authors.affiliation: Department of Epidemiology, Erasmus MC, 3000 CA Rotterdam, The Netherlands; Netherlands Genomics Initiative-Sponsored Netherlands Consortium for Healthy Ageing (NCHA), 2300 RC Leiden, The Netherlands.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
authors.affiliation: Department of Internal Medicine, Erasmus MC, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, 3000 CA Rotterdam, The Netherlands; Netherlands Genomics Initiative-Sponsored Netherlands Consortium for Healthy Ageing (NCHA), 2300 RC Leiden, The Netherlands. Electronic address: m.c.zillikens@erasmusmc.nl.
authors.forename: M Carola
authors.initials: MC
authors.lastname: Zillikens
mesh_terms: D015502:Absorptiometry, Photon; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015519:Bone Density; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004958:Estradiol / Q000097:blood; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010024:Osteoporosis / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D058866:Osteoporotic Fractures / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*
chemical_list: D015415:Biomarkers; D004958:Estradiol
keywords: BMD loss; Bone turnover; Coronary artery calcification; Estradiol levels