title: Systemic markers of microvascular disease and bone mineral density in older adults : The cardiovascular health study.
abstract: Here we report that abnormal brain white matter and, to a lesser extent, albuminuria are associated with reduced bone mineral density in the hip, spine, and total body in men and women. These findings may explain the increased hip fracture risk reported in some studies in association with microvascular disorders.
  
  
  
  Markers of microvascular disease have been individually associated with increased risk of osteoporotic fractures in some studies. Here, we examine whether these markers are associated with reduced bone mineral density (BMD) individually and together.
  
  
  
  BMD testing using dual x-ray absorptiometry of the hip, lumbar spine, and total body was performed in 1473 participants from the Cardiovascular Health Study (mean age ~ 78 years): 1215 were assessed for urinary albumin-creatinine ratio, 944 for abnormal white matter disease (AWMD) by brain MRI, and 541 for retinal vascular disease with fundus photographs. Linear regression models were used to evaluate the cross-sectional association of each marker with BMD accounting for potentially confounding factors.
  
  
  
  AWMD was associated with lower hip, spine, and total body BMD in women (β -3.08 to -4.53; p < 0.01 for all) and lower hip and total body BMD in men (β -2.90 to -4.24; p = 0.01-0.03). Albuminuria was associated with lower hip (β -3.37; p = .05) and total body (β -3.21; p = .02) BMD in men, but not in women. The associations of AWMD and albuminuria with BMD persisted with mutual adjustment and appeared to be additive to each other. Retinal vascular disease was not associated with BMD in men or women.
  
  
  
  AWMD and, to a lesser extent, albuminuria were independently associated with lower BMD, suggesting that microvascular disease may play a role in the pathogenesis of reduced BMD. These findings need to be confirmed by longitudinal studies.
authors.affiliation: Kaiser Permanente of Georgia, Division of Endocrinology and the Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA. joshua.barzilay@kp.org.|Kaiser Permanente of Georgia, 3650 Steve Reynolds Blvd, Duluth, GA, 30096, USA. joshua.barzilay@kp.org.
authors.forename: J I
authors.initials: JI
authors.lastname: Barzilay
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA, USA.
authors.forename: P
authors.initials: P
authors.lastname: Bůžková
authors.affiliation: Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, MN, USA.
authors.forename: H A
authors.initials: HA
authors.lastname: Fink
authors.affiliation: Department of Epidemiology, Graduate School, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Cauley
authors.affiliation: Department of Medicine, University of California at Davis, Modesto, CA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Robbins
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, MA, USA.
authors.forename: P S
authors.initials: PS
authors.lastname: Garimella
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
authors.forename: D I
authors.initials: DI
authors.lastname: Jalal
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Mukamal
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000453:epidemiology; D015519:Bone Density; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology*; D056784:Leukoencephalopathies / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008833:Microcirculation; D058866:Osteoporotic Fractures; D012164:Retinal Diseases / Q000453:epidemiology*; D012307:Risk Factors
chemical_list: D003404:Creatinine
keywords: Albuminuria; Bone mineral density; Brain white matter disease; Osteoporosis; Retinal vascular disease