Association between bone mineral density and coronary plaque burden in patients with coronary artery disease: a cross-sectional study using quantitative computed tomography.

PURPOSE: To evaluate the association between osteoporosis and coronary calcification and coronary plaque burden in patients with atherosclerosis and coronary artery disease (CAD).

METHODS: This study included 290 men and 177 postmenopausal women with angiography-confirmed atherosclerosis or CAD who underwent chest multidetector row computed tomography covering L1-L2 between September 2020 and October 2021. Quantitative computed tomography was used to measure the lumbar vertebra's bone mineral density (BMD). The coronary artery calcium score (CACS) and total coronary plaque burden were quantified using the Agatston and modified Gensini scores, respectively. Associations between BMD and CACS and modified Gensini scores were assessed using multivariate regression analysis. Lasso regression was used in model selection.

RESULTS: In men, BMD was inversely associated with CACS [β = -0.24; 95% confidence interval (CI), -0.35 to -0.13; P < 0.001) and coronary artery calcification (CAC) presence [odds ratio (OR) = 0.71; 95% CI, 0.52-0.96; P = 0.03) in the unadjusted model. After adjusting for age, modified Gensini score, prior percutaneous coronary intervention and hypertension, BMD was inversely associated with CACS (β = -0.11; 95% CI, -0.22 to -0.01; P = 0.04). In postmenopausal women, BMD was inversely associated with CACS (β = -0.24; 95% CI, -0.39 to 0.10; P < 0.001) and CAC presence (OR = 0.66; 95% CI, 0.47-0.92; P = 0.01) in the unadjusted model but no other models (P > 0.05). In both sexes, BMD did not correlate with the modified Gensini score or CAD prevalence (all P > 0.05).

CONCLUSION: In patients with coronary atherosclerosis and CAD, BMD of the lumbar vertebra correlated inversely with CACS in men but not postmenopausal women. Additionally, BMD did not correlate with the modified Gensini score in both sexes.