J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website https://www.jofem.org

Original Article

Volume 12, Number 4-5, October 2022, pages 125-133

Bone Mineral Density as a Predictor of Cardiovascular Disease in Women: A Real-World Retrospective Study

**Table 1.** Baseline Characteristics of the Enrolled Population
Baseline characteristics	N = 1,995
Osteopenia was defined as a BMD T score between -1.0 and -2.5, and osteoporosis was defined as a T score below -2.5. SD: standard deviation; SEM: standard error of the mean; BMD: bone mineral density.
Age (years)
N	1,995
Mean (SD)	72.55 (10.067)
SEM	0.225
Median	73
Q1 - Q3	66 - 79
Min - Max	32 - 100
Race, n (%)
Asian	3 (0.2%)
Black	135 (6.8%)
Hispanic	29 (1.5%)
Other	95 (4.8%)
Unknown	24 (1.2%)
White	1,709 (85.7%)
Status
Alive	1,798 (90.1%)
Dead	197 (9.9%)
Hypertension
No	797 (39.9%)
Yes	1,198 (60.1%)
Hyperlipidemia
No	791 (39.6%)
Yes	1,204 (60.4%)
Diabetes mellitus
No	1,771 (88.8%)
Yes	224 (11.2%)
Stroke
No	1919 (96.2%)
Yes	76 (3.8%)
Myocardial infraction
No	1,909 (95.7%)
Yes	86 (4.3%)
Cardiac death
No	102 (5.1%)
Yes	39 (2.0%)
Cardiac event
No	1,827 (91.6%)
Yes	168 (8.4%)
Smoking status
Active smoker	385 (19.3%)
Former smoker	1,610 (80.7%)
BMD hip
Normal	1,126 (56.4%)
Osteopenia	692 (34.7%)
Osteoporosis	166 (8.3%)
Right femur
Normal	445 (22.3%)
Osteopenia	965 (48.4%)
Osteoporosis	158 (7.9%)
Left femur
Normal	544 (27.3%)
Osteopenia	1,119 (56.1%)
Osteoporosis	325 (16.3%)
Combined (hip, right and left femur)
Normal	413 (20.7%)
Osteopenia	1,142 (57.2%)
Osteoporosis	440 (22.1%)
Height
N	1,572
Mean (SD)	63.37 (2.770)
SEM	0.070
Median	63
Q1 - Q3	62 - 65
Min - Max	54 - 73
Weight
N	1,634
Mean (SD)	166.84 (42.318)
SEM	1.047
Median	160
Q1 - Q3	136 - 189
Min - Max	82 - 340
BMI
N	1,579
Mean (SD)	29.29 (7.185)
SEM	0.181
Median	28
Q1 - Q3	24 - 33
Min - Max	14 - 64
BMD-hip score
N	1,984
Mean (SD)	-0.55 (1.573)
SEM	0.035
Median	-1
Q1 - Q3	-2 - 0
Min - Max	-5 - 6
Right femur score
N	1,568
Mean (SD)	-1.38 (1.047)
SEM	0.026
Median	-2
Q1 - Q3	-2 to -1
Min - Max	-8 - 3
Left femur score
N	1,988
Mean (SD)	-1.51 (1.132)
SEM	0.025
Median	-2
Q1 - Q3	-2 to -1
Min - Max	-7 - 3

Table 1. Baseline Characteristics of the Enrolled Population

Baseline characteristics

N = 1,995

Osteopenia was defined as a BMD T score between -1.0 and -2.5, and osteoporosis was defined as a T score below -2.5. SD: standard deviation; SEM: standard error of the mean; BMD: bone mineral density.

Age (years)

1,995

Mean (SD)

72.55 (10.067)

SEM

0.225

Median

Q1 - Q3

66 - 79

Min - Max

32 - 100

Race, n (%)

Asian

3 (0.2%)

Black

135 (6.8%)

Hispanic

29 (1.5%)

Other

95 (4.8%)

Unknown

24 (1.2%)

White

1,709 (85.7%)

Status

Alive

1,798 (90.1%)

Dead

197 (9.9%)

Hypertension

797 (39.9%)

Yes

1,198 (60.1%)

Hyperlipidemia

791 (39.6%)

Yes

1,204 (60.4%)

Diabetes mellitus

1,771 (88.8%)

Yes

224 (11.2%)

Stroke

1919 (96.2%)

Yes

76 (3.8%)

Myocardial infraction

1,909 (95.7%)

Yes

86 (4.3%)

Cardiac death

102 (5.1%)

Yes

39 (2.0%)

Cardiac event

1,827 (91.6%)

Yes

168 (8.4%)

Smoking status

Active smoker

385 (19.3%)

Former smoker

1,610 (80.7%)

BMD hip

Normal

1,126 (56.4%)

Osteopenia

692 (34.7%)

Osteoporosis

166 (8.3%)

Right femur

Normal

445 (22.3%)

Osteopenia

965 (48.4%)

Osteoporosis

158 (7.9%)

Left femur

Normal

544 (27.3%)

Osteopenia

1,119 (56.1%)

Osteoporosis

325 (16.3%)

Combined (hip, right and left femur)

Normal

413 (20.7%)

Osteopenia

1,142 (57.2%)

Osteoporosis

440 (22.1%)

Height

1,572

Mean (SD)

63.37 (2.770)

SEM

0.070

Median

Q1 - Q3

62 - 65

Min - Max

54 - 73

Weight

1,634

Mean (SD)

166.84 (42.318)

SEM

1.047

Median

160

Q1 - Q3

136 - 189

Min - Max

82 - 340

BMI

1,579

Mean (SD)

29.29 (7.185)

SEM

0.181

Median

Q1 - Q3

24 - 33

Min - Max

14 - 64

BMD-hip score

1,984

Mean (SD)

-0.55 (1.573)

SEM

0.035

Median

-1

Q1 - Q3

-2 - 0

Min - Max

-5 - 6

Right femur score

1,568

Mean (SD)

-1.38 (1.047)

SEM

0.026

Median

-2

Q1 - Q3

-2 to -1

Min - Max

-8 - 3

Left femur score

1,988

Mean (SD)

-1.51 (1.132)

SEM

0.025

Median

-2

Q1 - Q3

-2 to -1

Min - Max

-7 - 3

**Table 2.** Logistic Regression Model for ASCVD and BMD
Parameter	OR	CI	P-value
Only non-missing values were included. Cardiac event = “Yes”, if a patient had (stroke, MI or cardiac death). ASCVD: atherosclerotic cardiovascular disease; BMD: bone mineral density; OR: odds ratio; CI: confidence interval.
Combined
Normal	Reference
Osteopenia	1.31	0.779 - 2.212	0.3062
Osteoporosis	4.68	2.783 - 7.867	< 0.0001
Right femur
Normal	Reference
Osteopenia	1.69	1.014 - 2.809	0.0441
Osteoporosis	6.50	3.637 - 11.608	< 0.0001
Left femur
Normal	Reference
Osteopenia	1.34	0.849 - 2.104	0.2106
Osteoporosis	5.07	3.166 - 8.108	< 0.0001
Hip
Normal	Reference
Osteopenia	1.49	1.050 - 2.119	0.0255
Osteoporosis	3.36	2.127 - 5.312	< 0.0001

Table 2. Logistic Regression Model for ASCVD and BMD

Parameter

P-value

Only non-missing values were included. Cardiac event = “Yes”, if a patient had (stroke, MI or cardiac death). ASCVD: atherosclerotic cardiovascular disease; BMD: bone mineral density; OR: odds ratio; CI: confidence interval.

Combined

Normal

Reference

Osteopenia

1.31

0.779 - 2.212

0.3062

Osteoporosis

4.68

2.783 - 7.867

< 0.0001

Right femur

Normal

Reference

Osteopenia

1.69

1.014 - 2.809

0.0441

Osteoporosis

6.50

3.637 - 11.608

< 0.0001

Left femur

Normal

Reference

Osteopenia

1.34

0.849 - 2.104

0.2106

Osteoporosis

5.07

3.166 - 8.108

< 0.0001

Hip

Normal

Reference

Osteopenia

1.49

1.050 - 2.119

0.0255

Osteoporosis

3.36

2.127 - 5.312

< 0.0001

**Table 3.** Logistic Regression Model for ASCVD, BMD and Other Covariates
Parameter	OR	CI	P-value
Only non-missing values were included. Cardiac event = “Yes”, if a patient had (stroke, MI or cardiac death). ASCVD: atherosclerotic cardiovascular disease; BMD: bone mineral density; OR: odds ratio; CI: confidence interval.
Combined (hip, right and left femur)
Normal	Reference
Osteopenia	1.26	0.736 - 2.157	0.3987
Osteoporosis	4.44	2.559 - 7.701	< 0.0001
Age (years)	1.02	1.005 - 1.043	0.0137
Smoking status, n (%)
No/former smoker	Reference
Active smoker	1.41	0.905 - 2.186	0.1292
Diabetes mellitus
No	Reference
Yes	2.33	1.529 - 3.551	< 0.0001
Hypertension
No	Reference
Yes	2.30	1.456 - 3.622	0.0003
Hyperlipidemia
No	Reference
Yes	1.47	0.970 - 2.236	0.0693

Table 3. Logistic Regression Model for ASCVD, BMD and Other Covariates

Parameter

P-value

Combined (hip, right and left femur)

Normal

Reference

Osteopenia

1.26

0.736 - 2.157

0.3987

Osteoporosis

4.44

2.559 - 7.701

< 0.0001

Age (years)

1.02

1.005 - 1.043

0.0137

Smoking status, n (%)

No/former smoker

Reference

Active smoker

1.41

0.905 - 2.186

0.1292

Diabetes mellitus

Reference

Yes

2.33

1.529 - 3.551

< 0.0001

Hypertension

Reference

Yes

2.30

1.456 - 3.622

0.0003

Hyperlipidemia

Reference

Yes

1.47

0.970 - 2.236

0.0693

**Table 4.** Logistic Regression Model for BMD and MI
Parameter	OR	CI	P-value
Only non-missing values were included. BMD: bone mineral density; MI: myocardial infarction; OR: odds ratio; CI: confidence interval.
Combined
Normal	Reference
Osteopenia	1.24	0.605 - 2.526	0.5600
Osteoporosis	4.25	2.105 - 8.593	< 0.0001
Right femur
Normal	Reference
Osteopenia	1.49	0.727 - 3.062	0.2755
Osteoporosis	5.59	2.523 - 12.400	< 0.0001
Left femur
Normal	Reference
Osteopenia	1.10	0.603 - 1.995	0.7617
Osteoporosis	3.86	2.093 - 7.105	< 0.0001
Hip
Normal	Reference
Osteopenia	1.47	0.913 - 2.380	0.1126
Osteoporosis	2.92	1.567 - 5.455	0.0007

Table 4. Logistic Regression Model for BMD and MI

Parameter

P-value

Only non-missing values were included. BMD: bone mineral density; MI: myocardial infarction; OR: odds ratio; CI: confidence interval.

Combined

Normal

Reference

Osteopenia

1.24

0.605 - 2.526

0.5600

Osteoporosis

4.25

2.105 - 8.593

< 0.0001

Right femur

Normal

Reference

Osteopenia

1.49

0.727 - 3.062

0.2755

Osteoporosis

5.59

2.523 - 12.400

< 0.0001

Left femur

Normal

Reference

Osteopenia

1.10

0.603 - 1.995

0.7617

Osteoporosis

3.86

2.093 - 7.105

< 0.0001

Hip

Normal

Reference

Osteopenia

1.47

0.913 - 2.380

0.1126

Osteoporosis

2.92

1.567 - 5.455

0.0007

**Table 5.** Logistic Regression Model for Stroke and BMD
Parameter	OR	CI	P-value
Only non-missing values were included. BMD: bone mineral density; OR: odds ratio; CI: confidence interval.
Combined
Normal	Reference
Osteopenia	1.38	0.655 - 2.897	0.3986
Osteoporosis	3.64	1.720 - 7.703	0.0007
Right femur
Normal	Reference
Osteopenia	1.78	0.880 - 3.612	0.1083
Osteoporosis	4.90	2.175 - 11.045	0.0001
Left femur
Normal	Reference
Osteopenia	1.32	0.692 - 2.514	0.4004
Osteoporosis	3.85	1.965 - 7.548	< 0.0001
Hip
Normal	Reference
Osteopenia	1.46	0.882 - 2.401	0.1415
Osteoporosis	2.50	1.269 - 4.938	0.0081

Table 5. Logistic Regression Model for Stroke and BMD

Parameter

P-value

Only non-missing values were included. BMD: bone mineral density; OR: odds ratio; CI: confidence interval.

Combined

Normal

Reference

Osteopenia

1.38

0.655 - 2.897

0.3986

Osteoporosis

3.64

1.720 - 7.703

0.0007

Right femur

Normal

Reference

Osteopenia

1.78

0.880 - 3.612

0.1083

Osteoporosis

4.90

2.175 - 11.045

0.0001

Left femur

Normal

Reference

Osteopenia

1.32

0.692 - 2.514

0.4004

Osteoporosis

3.85

1.965 - 7.548

< 0.0001

Hip

Normal

Reference

Osteopenia

1.46

0.882 - 2.401

0.1415

Osteoporosis

2.50

1.269 - 4.938

0.0081

**Table 6.** Logistic Regression Model for MI, BMD and Other Covariates
Parameter	OR	CI	P-value
Only non-missing values were included. BMD: bone mineral density; MI: myocardial infarction; OR: odds ratio; CI: confidence interval.
Combined (hip, right and left femur)
Normal	Reference
Osteopenia	1.16	0.556 - 2.409	0.6952
Osteoporosis	3.80	1.810 - 7.979	0.0004
Age (years)	1.02	0.995 - 1.047	0.1098
Smoking status, n (%)
No/former smoker	Reference
Active smoker	1.87	1.059 - 3.299	0.0311
Diabetes mellitus
No	Reference
Yes	1.59	0.907 - 2.775	0.1054
Hypertension
No	Reference
Yes	4.43	2.029 - 9.690	0.0002
Hyperlipidemia
No	Reference
Yes	2.38	1.234 - 4.595	0.0097

Table 6. Logistic Regression Model for MI, BMD and Other Covariates

Parameter

P-value

Only non-missing values were included. BMD: bone mineral density; MI: myocardial infarction; OR: odds ratio; CI: confidence interval.

Combined (hip, right and left femur)

Normal

Reference

Osteopenia

1.16

0.556 - 2.409

0.6952

Osteoporosis

3.80

1.810 - 7.979

0.0004

Age (years)

1.02

0.995 - 1.047

0.1098

Smoking status, n (%)

No/former smoker

Reference

Active smoker

1.87

1.059 - 3.299

0.0311

Diabetes mellitus

Reference

Yes

1.59

0.907 - 2.775

0.1054

Hypertension

Reference

Yes

4.43

2.029 - 9.690

0.0002

Hyperlipidemia

Reference

Yes

2.38

1.234 - 4.595

0.0097

**Table 7.** Logistic Regression Model for Stroke, BMD and Other Covariates
Parameter	OR	CI	P-value
Only non-missing values were included. BMD: bone mineral density; OR: odds ratio; CI: confidence interval.
Combined (hip, right and left femur)
Normal	Reference
Osteopenia	1.33	0.620 - 2.834	0.4674
Osteoporosis	3.40	1.551 - 7.447	0.0022
Age (years)	1.02	0.998 - 1.052	0.0669
Smoking status, n (%)
No/former smoker	Reference
Active smoker	0.99	0.508 - 1.924	0.9727
Diabetes mellitus
No	Reference
Yes	2.89	1.630 - 5.132	0.0003
Hypertension
No	Reference
Yes	1.29	0.709 - 2.337	0.4072
Hyperlipidemia
No	Reference
Yes	1.11	0.628 - 1.968	0.7152

Table 7. Logistic Regression Model for Stroke, BMD and Other Covariates

Parameter

P-value

Only non-missing values were included. BMD: bone mineral density; OR: odds ratio; CI: confidence interval.

Combined (hip, right and left femur)

Normal

Reference

Osteopenia

1.33

0.620 - 2.834

0.4674

Osteoporosis

3.40

1.551 - 7.447

0.0022

Age (years)

1.02

0.998 - 1.052

0.0669

Smoking status, n (%)

No/former smoker

Reference

Active smoker

0.99

0.508 - 1.924

0.9727

Diabetes mellitus

Reference

Yes

2.89

1.630 - 5.132

0.0003

Hypertension

Reference

Yes

1.29

0.709 - 2.337

0.4072

Hyperlipidemia

Reference

Yes

1.11

0.628 - 1.968

0.7152

**Table 8.** Logistic Regression Model for BMD and Cardiac Death
Parameter	OR	CI	P-value
Only non-missing values were included. BMD: bone mineral density; OR: odds ratio; CI: confidence interval.
Combined
Normal	Reference
Osteopenia	0.59	0.327 - 1.065	0.0802
Osteoporosis	0.21	0.114 - 0.375	< 0.0001
Right femur
Normal	Reference
Osteopenia	0.38	0.210 - 0.704	0.0019
Osteoporosis	0.16	0.081 - 0.328	< 0.0001
Left femur
Normal	Reference
Osteopenia	0.50	0.297 - 0.855	0.0110
Osteoporosis	0.18	0.104 - 0.316	< 0.0001
Hip
Normal	Reference
Osteopenia	0.88	0.600 - 1.282	0.4972
Osteoporosis	0.43	0.256 - 0.707	0.0010

Table 8. Logistic Regression Model for BMD and Cardiac Death

Parameter

P-value

Only non-missing values were included. BMD: bone mineral density; OR: odds ratio; CI: confidence interval.

Combined

Normal

Reference

Osteopenia

0.59

0.327 - 1.065

0.0802

Osteoporosis

0.21

0.114 - 0.375

< 0.0001

Right femur

Normal

Reference

Osteopenia

0.38

0.210 - 0.704

0.0019

Osteoporosis

0.16

0.081 - 0.328

< 0.0001

Left femur

Normal

Reference

Osteopenia

0.50

0.297 - 0.855

0.0110

Osteoporosis

0.18

0.104 - 0.316

< 0.0001

Hip

Normal

Reference

Osteopenia

0.88

0.600 - 1.282

0.4972

Osteoporosis

0.43

0.256 - 0.707

0.0010

**Table 9.** Logistic Regression Model for Cardiac Death, BMD and Other Covariates
Parameter	OR	CI	P-value
Only non-missing values were included. BMD: bone mineral density; OR: odds ratio; CI: confidence interval.
Combined (hip, right and left femur)
Normal	Reference
Osteopenia	0.65	0.356 - 1.198	0.1684
Osteoporosis	0.24	0.130 - 0.457	< 0.0001
Age (years)	0.96	0.940 - 0.978	< 0.0001
Smoking status, n (%)
No/former smoker	Reference
Active smoker	0.72	0.444 - 1.181	0.1957
Diabetes mellitus
No	Reference
Yes	0.38	0.241 - 0.586	< 0.0001
Hypertension
No	Reference
Yes	0.39	0.235 - 0.643	0.0002
Hyperlipidemia
No	Reference
Yes	1.07	0.698 - 1.641	0.7561

Table 9. Logistic Regression Model for Cardiac Death, BMD and Other Covariates

Parameter

P-value

Only non-missing values were included. BMD: bone mineral density; OR: odds ratio; CI: confidence interval.

Combined (hip, right and left femur)

Normal

Reference

Osteopenia

0.65

0.356 - 1.198

0.1684

Osteoporosis

0.24

0.130 - 0.457

< 0.0001

Age (years)

0.96

0.940 - 0.978

< 0.0001

Smoking status, n (%)

No/former smoker

Reference

Active smoker

0.72

0.444 - 1.181

0.1957

Diabetes mellitus

Reference

Yes

0.38

0.241 - 0.586

< 0.0001

Hypertension

Reference

Yes

0.39

0.235 - 0.643

0.0002

Hyperlipidemia

Reference

Yes

1.07

0.698 - 1.641

0.7561

**Table 10.** Linear Regression for BMD and ASCVD
Parameter	Estimate	CI	P-value
ASCVD: atherosclerotic cardiovascular disease; BMD: bone mineral density; CI: confidence interval.
Hip score
No cardiac event	Reference
Cardiac event	-0.58	-0.83, -0.33	< 0.0001
Left femur score
No cardiac event	Reference
Cardiac event	-0.79	-0.96, -0.61	< 0.0001
Right femur score
No cardiac event	Reference
Cardiac event	-0.58	-0.77, -0.39	< 0.0001
Combined
No cardiac event	Reference
Cardiac event	-0.78	-0.95, -0.60	< 0.0001

Table 10. Linear Regression for BMD and ASCVD

Parameter

Estimate

P-value

ASCVD: atherosclerotic cardiovascular disease; BMD: bone mineral density; CI: confidence interval.

Hip score

No cardiac event

Reference

Cardiac event

-0.58

-0.83, -0.33

< 0.0001

Left femur score

No cardiac event

Reference

Cardiac event

-0.79

-0.96, -0.61

< 0.0001

Right femur score

No cardiac event

Reference

Cardiac event

-0.58

-0.77, -0.39

< 0.0001

Combined

No cardiac event

Reference

Cardiac event

-0.78

-0.95, -0.60

< 0.0001