title: Abdominal Aortic Calcification Identified on Lateral Spine Images From Bone Densitometers Are a Marker of Generalized Atherosclerosis in Elderly Women.
abstract: OBJECTIVE
  Dual-energy x-ray absorptiometry is a low-cost, minimal radiation technique used to improve fracture prediction. Dual-energy x-ray absorptiometry machines can also capture single-energy lateral spine images, and abdominal aortic calcification (AAC) is commonly seen on these images.
  
  
  RESULTS
  We investigated whether dual-energy x-ray absorptiometry-derived measures of AAC were related to an established test of generalized atherosclerosis in 892 elderly white women aged >70 years with images captured during bone density testing in 1998/1999 and B-mode carotid ultrasound in 2001. AAC scores were calculated using a validated 24-point scale into low (AAC24 score, 0 or 1), moderate (AAC24 scores, 2-5), and severe AAC (AAC24 scores, >5) seen in 45%, 36%, and 19%, respectively. AAC24 scores were correlated with mean and maximum common carotid artery intimal medial thickness (rs=0.12, P<0.001 and rs=0.14, P<0.001). Compared with individuals with low AAC, those with moderate or severe calcification were more likely to have carotid atherosclerotic plaque (adjusted prevalence ratio (PR), 1.35; 95% confidence interval, 1.14-1.61; P<0.001 and prevalence ratio, 1.94; 95% confidence interval, 1.65-2.32; P<0.001, respectively) and moderate carotid stenosis (adjusted prevalence ratio, 2.22; 95% confidence interval, 1.39-3.54; P=0.001 and adjusted prevalence ratio, 4.82; 95% confidence interval, 3.09-7.050; P<0.001, respectively). The addition of AAC24 scores to traditional risk factors improved identification of women with carotid atherosclerosis as quantified by C-statistic (+0.075, P<0.001), net reclassification (0.249, P<0.001), and integrated discrimination (0.065, P<0.001).
  
  
  CONCLUSIONS
  AAC identified on images from a dual-energy x-ray absorptiometry machine were strongly related to carotid ultrasound measures of atherosclerosis. This low-cost, minimal radiation technique used widely for osteoporosis screening is a promising marker of generalized extracoronary atherosclerosis.
authors.affiliation: University of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, Perth, Australia.|Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia.|Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Lewis
authors.affiliation: Park Nicollet Osteoporosis Center and Institute for Research and Education, Minneapolis, MN, USA and Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Schousboe
authors.affiliation: University of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, Perth, Australia.|Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.
authors.forename: Wai H
authors.initials: WH
authors.lastname: Lim
authors.affiliation: Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.affiliation: University of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, Perth, Australia.|Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia.
authors.forename: Kun
authors.initials: K
authors.lastname: Zhu
authors.affiliation: Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia.|PathWest, Sir Charles Gairdner Hospital, Perth, Australia.
authors.forename: Ee M
authors.initials: EM
authors.lastname: Lim
authors.affiliation: Skeletal Health, Hologic, Inc., Bedford, MA, USA.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Wilson
authors.affiliation: Department of Cardiology, Sir Charles Gairdner Hospital, Perth, Australia.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Thompson
authors.affiliation: Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Kiel
authors.affiliation: University of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, Perth, Australia.|Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Prince
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging*; D001018:Aortic Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D001027:Aortography; D050197:Atherosclerosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D005260:Female; D006801:Humans; D033162:Incidental Findings; D010024:Osteoporosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D013131:Spine / Q000000981:diagnostic imaging*; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014904:Western Australia / Q000453:epidemiology
keywords: atherosclerosis; bone density; cardiovascular disease; common carotid artery; osteoporosis