Bone mineral density and atherosclerosis: The Multi-Ethnic Study of Atherosclerosis, Abdominal Aortic Calcium Study

Context: Molecular and cell biology studies have demonstrated an association between bone and arterial wall disease, but the significance of a population-level association is less clear and potentially confounded by inability to account for shared risk factors. Objective: To test population-level associations between atherosclerosis types and bone integrity. Main outcome measures: Volumetric trabecular lumbar bone mineral density (vBMD), ankle-brachial index (ABI), intima-media thickness (IMT) of the common carotid (CCA-IMT) and internal carotid (ICA-IMT) arteries, and carotid plaque echogenicity. Design, setting and participants: A random subset of participants from the Multi-Ethnic Study of Atherosclerosis (MESA) assessed between 2002 and 2005. Results: 904 post-menopausal female (62.4 years; 62% non-white; 12% ABI < 1; 17% CCA-IMT > 1 mm; 33% ICA-IMT > 1 mm) and 929 male (61.4 years; 58% non-white; 6% ABI < 1; 25% CCA-IMT > 1 mm; 40% ICA-IMT > 1mm) were included. In serial, sex-specific regression models adjusting for age, ethnicity, body mass index, dyslipidemia, hypertension, smoking, alcohol consumption, diabetes, homocysteine, interleukin-6, sex hormones, and renal function, lower vBMD was associated with lower ABI in men (p for trend < 0.01) and greater ICA-IMT in men (p for trend < 0.02). CCA-IMT was not associated with vBMD in men or women. Carotid plaque echogenicity was independently associated with lower vBMD in both men (trend p = 0.01) and women (trend p < 0.04). In all models, adjustment did not materially affect results. Conclusions: Lower vBMD is independently associated with structural and functional measures of atherosclerosis in men and with more advanced and calcified carotid atherosclerotic plaques in both sexes. (C) 2009 Elsevier Ireland Ltd. All rights reserved.