Background Osteoporosis and cardiovascular diseases are two major public health problems. Both are associated with high morbidity, long-term hospitalization, mortality and loss of independence leading to institutionalization. Vertebral morphometry using dual-energy X-ray absorptiometry (DXA) also known as vertebral fracture assessment (VFA) is a fast, low-radiation technique which produces images that are of sufficient quality to be used to diagnose the presence of vertebral deformity consistent with fracture. VFA has demonstrated utility for vertebral visualization and thus is an important tool for fracture detection in women and men. It has been shown also in many populations that this technique can simultaneously identify abdominal aortic calcification (AAC). Hyperhomocysteinemia, a condition that recent epidemiological studies have shown to be associated with increased risk of vascular disease. A potential role of homocysteine in bone fragility has been considered from the observation of a high prevalence of osteoporosis in subjects with homocystinuria.
Objectives The main of this study was to examine the relationship between plasma homocysteine (Hcy), asymptomatic osteoporotic vertebral fractures (VFs) using vertebral fracture assessment (VFA) and prevalent abdominal aortic calcification (AAC) in Moroccan postmenopausal women.
Methods The study cohort consisted of 188 consecutive postmenopausal women with no prior known diagnosis of osteoporosis or taking medication interfering with bone metabolism. Mean age, weight, height, body mass index and plasma homocysteine were determined. Lateral VFA images and scans of the lumbar spine and proximal femur were obtained using a Lunar Prodigy Vision densitometer (GE Healthcare Inc., Waukesha, WI). VFs were defined using a combination of Genant's semiquantitative approach and morphometry. VFA images were also scored for prevalent AAC using a validated 24 point scale.
Results Fifty-eight (30.9%) patients had densitometric osteoporosis. VFs were identified using VFA in 76 (40.4%) patients: 61 women had grade 1 VFs and 15 had grade 2 or 3 VFs. One hundred twenty nine women (68.6%) did not have any detectable AAC, whereas the prevalence of significant atherosclerotic burden defined as AAC score of 5 or higher, was 13.8%. A significant positive correlation between AAC score and homocysteine was observed. Women with extended AAC, were older, had a lower weight, BMI and BMD, higher homocysteine levels and more prevalent VFs than women without extended AAC. Multiple regression analysis showed that the presence of extended AAC was significantly associated with Age and grade 2/3 VFs and not independently associated with homocysteine levels.
Conclusions This study did not confirm that homocysteine is important determinant of extended AAC in postmenopausal women. However, this significant atherosclerotic marker is independently associated with VFs regardless of age.
Disclosure of Interest None declared