title: Relationship Between Low Bone Mineral Density and Fractures With Incident Cardiovascular Disease: A Systematic Review and Meta-Analysis.
abstract: An increasing evidence base suggests that low bone mineral density (BMD) and fractures are associated with cardiovascular disease (CVD). We conducted a systematic review and meta-analysis summarizing the evidence of low BMD and fractures as risk factors for future CVD. Two independent authors searched major databases from inception to August 1, 2016, for longitudinal studies reporting data on CVD incidence (overall and specific CVD) and BMD status and fractures. The association between low BMD, fractures, and CVD across longitudinal studies was explored by calculating pooled adjusted hazard ratios (HRs) ±95% confidence intervals (CIs) with a random-effects meta-analysis. Twenty-eight studies (18 regarding BMD and 10 fractures) followed a total of 1,107,885 participants for a median of 5 years. Taking those with higher BMD as the reference, people with low BMD were at increased risk of developing CVD during follow-up (11 studies; HR = 1.33; 95%CI, 1.27 to 1.38; I2= 53%), after adjusting for a median of eight confounders. This finding was confirmed using a decrease in one standard deviation of baseline BMD (9 studies; HR = 1.16; 95% CI, 1.09 to 1.24; I2= 69%). The presence of fractures at baseline was associated with an increased risk of developing CVD (HR = 1.20; 95% CI, 1.06 to 1.37; I2= 91%). Regarding specific CVDs, low BMD was associated with an increased risk of developing coronary artery disease, cerebrovascular conditions, and CVD-associated death. Fractures at baseline was associated with an increased risk of cerebrovascular conditions and death due to CVD. In conclusion, low BMD and fractures are associated with a small, but significant increased risk of CVD risk and possibly death. © 2017 American Society for Bone and Mineral Research.
authors.affiliation: Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy.|National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Veronese
authors.affiliation: Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.|Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK.|Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK.
authors.forename: Brendon
authors.initials: B
authors.lastname: Stubbs
authors.affiliation: National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Crepaldi
authors.affiliation: Department of Neurosciences, University of Padova, Padova, Italy.|National Health Care System, Padova Local Unit ULSS 17, Padova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Solmi
authors.affiliation: Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK.|MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.|National Institute for Health Research Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Cooper
authors.affiliation: MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.
authors.forename: Nicolas Cw
authors.initials: NC
authors.lastname: Harvey
authors.affiliation: Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Reginster
authors.affiliation: Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Renè
authors.initials: R
authors.lastname: Rizzoli
authors.affiliation: Department of Medicine, Division of Bone and Mineral Diseases, Musculoskeletal Research Center, Washington University, St. Louis, MO, USA.
authors.forename: Roberto
authors.initials: R
authors.lastname: Civitelli
authors.affiliation: Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.
authors.forename: Patricia
authors.initials: P
authors.lastname: Schofield
authors.affiliation: National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Maggi
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Lamb
mesh_terms: D015519:Bone Density; D003324:Coronary Artery Disease / Q000378:metabolism* / Q000401:mortality*; D005260:Female; D050723:Fractures, Bone / Q000378:metabolism* / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors
keywords: BONE MINERAL DENSITY; CARDIOVASCULAR DISEASE; META-ANALYSIS; OSTEOPOROSIS