Osteoporosis as an independent risk factor for silent brain infarction and white matter changes in men and women: the PRESENT project.

Abstract

Previous studies have not demonstrated a relationship between osteoporosis and cerebral infarction in the community, especially in men. We found that osteoporosis may be an independent risk factor for brain white matter change/silent infarction in men, as well as in women. We aimed to study the relationship between low bone mineral density (BMD) and brain white matter changes and/or silent infarcts (WMC/SI). This was a community-based, cross-sectional study supported by the regional government. Bone mineral density measurements and brain computed tomography were performed in 646 stroke- and dementia-free subjects (aged 50-75 years). After adjustment for age, hypertension, diabetes mellitus, dyslipidemia, and current smoking status, the odds ratio (OR) of risk for WMC and/or SI was 1.8 in the osteopenia group (95 % confidence interval [CI] 1.15-2.77; P = 0.01) and 2.2 in the osteoporosis group (95 % CI 1.42-3.55; P < 0.001). Among men, the OR was 1.8 (95 % CI 0.72-4.62; P = 0.21) and 3.8 (95 % CI 1.63-8.86; P = 0.002), and in women, the OR was 1.9 (95 % CI 1.15-2.78; P = 0.010) and 2.2 (95 % CI 1.42-3.55; P = 0.001), respectively. Severe bone mass loss may be an independent risk factor for brain WMC/SI in men and women. Low BMD may cause brain WMC/SI in the step that leads to stroke. Although there are well-designed studies on the prevention of cerebral infarction in patients with brain WMC/SI, a specific prevention method, such as aspirin, should be used for patients with low BMD who have WMC/SI. Screening for low BMD as an independent vascular risk factor in healthy subjects may be required to prevent stroke.