Associations Between Bone Mineral Density and Subclinical Atherosclerosis: A Cross-Sectional Study of a Chinese Population

Context: The significance of associations between bone mineral density (BMD) and atherosclerosis in the Asian population is less clear. Objective: The aim of this study was to explore the population-level associations between BMD and subclinical atherosclerosis. Design and Setting: This was a community-based cross-sectional study conducted in Shenyang, China. Participants: A total of 385 Chinese women and men aged 37-87 years were studied. Main Outcome Measures: The BMD was measured at the total hip and lumbar spine using dual-energy x-ray absorptiometry. The ankle-brachial index (ABI), pulse wave velocity (PWV), and carotid intima-media thickness (CIMT) were measured to assess atherosclerosis. Multiple regression analysis was applied to study the associations. Multicolinearity was examined using the variance inflation factor, condition index, and variance proportions. Factor analysis and principal component regression were used to remove the problem of multicolinearity. Results: The differences of ABI, PWV, and CIMT among the normal BMD, osteopenia, and osteoporosis groups were not found. Total hip BMD was correlated with ABI in women after adjustment for age (r = 0.156). Sex-specific regression models included adjustment for age, body mass index, cigarette smoking, alcohol consumption, menopausal status (women), systolic blood pressure, diastolic blood pressure, triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting blood glucose, serum uric acid, estimated glomerular filtration rate, high-sensitivity C-reactive protein, and fibrinogen. Total hip BMD was associated with ABI in women after adjustment for age (per SD decrease in ABI: -0.130 g/cm(2), P = .022), but the association was borderline significant after full adjustment (P = .045). Total hip BMD and lumbar spine BMD were not associated with ABI, PWV, and CIMT after full adjustment in participants without a fracture history. The risk of osteoporosis was not associated with ABI, PWV, and CIMT. Conclusions: Low BMD is not associated with subclinical atherosclerosis as assessed by ABI, PWV, and CIMT.