Association between vertebral fractures and coronary artery calcification in current and former smokers in the ECLIPSE cohort

van Dort, M. J.; Driessen, J. H. M.; Geusens, P.; Romme, E. A. P. M.; Smeenk, F. W. J. M.; Rahel, B. M.; Eisman, J. A.; Wouters, E. F. M.; van den Bergh, J. P. W.

Affiliations

¹NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands

²Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands

³Department of Internal Medicine, Rheumatology, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands

⁴CAPHRI Care and Public Health Research Institute, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands

⁵Department of Respiratory Medicine, Catharina Hospital, Eindhoven, the Netherlands

⁶School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands

⁷Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands

⁸Department of Endocrinology, St Vincent’s Hospital, Sydney, Australia

⁹Garvan Institute of Medical Research, Sydney, Australia

¹⁰School of Medicine Sydney, University of Notre Dame, Sydney, Australia

¹¹University of New South Wales (UNSW Sydney), Sydney, Australia

¹²Department of Respiratory Diseases, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands

¹³Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands

Abstract and keywords

Summary: In smokers and former smokers from the ECLIPSE cohort, there is an association between prevalent vertebral fractures (VFs) and coronary artery calcification (CAC). Chest CT scans provide the opportunity to evaluate VFs and CAC, which are potentially important comorbidities, each of which is amenable to effective interventions.

Introduction: Prevalence of VFs among smokers and patients with chronic obstructive pulmonary disease (COPD) is high, and an association between CAC and osteoporosis has been described. We investigated the associations between VFs and CAC (expressed in Agatston score) in (former) smokers.

Methods: Current and former smokers from the ECLIPSE study (designed to determine underlying COPD progression mechanisms) were studied. Baseline Agatston score (zero (0), medium (1–400), or high (> 400)), baseline bone attenuation (BA), and prevalent and incident VFs (vertebrae T1–L1) were assessed on CT.

Results: A total of 586 subjects were included (mean age 59.8 ± 8.3; 62.3% men; 70.1% with COPD; 21.0% with prevalent VFs; 196 with zero, 266 with medium, and 124 with high Agatston score). Of these, 23.4% suffered incident VFs within 3 years. In multivariate models, prevalent VFs were associated with medium (1.83 [95% CI 1.01–3.30]) and with high (OR = 3.06 [1.45–6.47]) Agatston score. After adjustment for BA, prevalent VFs were still associated with high (OR = 2.47 [1.13–5.40]), but not significantly with medium Agatston score (OR = 1.57 [0.85–2.88]). Similarly, after adjustment for BA, high (OR = 2.06 [1.02–4.13]) but not medium Agatston score (OR = 1.61 [0.88–2.94]) was associated with prevalent VFs. Agatston score at baseline was not associated with short-term VF incidence.

Conclusion: In (former) smokers, there was an association between prevalent VFs and Agatston score. Chest CT scans provide the opportunity to also evaluate for VFs and CAC, which are potentially important comorbidities, each of which is amenable to effective interventions.

Keywords: Agatston score; Comorbidity; COPD; Coronary artery calcification; Smoking; Vertebral fracture

Links

DOI: 10.1007/s00198-019-05218-w

PubMed: 31768590

WoS: 000518182700009

History

Received: 2018-11-02

Accepted: 2019-10-30

Online: 2019-11-25

Cited Works (1)

Year	Entry
1993	Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. September 1993;8(9):1137-1148.