PERIPHERAL AND CENTRAL ARTERIAL PARAMETERS, BONE DENSITY AND FRACTURES

Abstract

Objective: Several studies have reported an association between hypertension and fracture incidence. Nevertheless, whether peripheral and central arterial parameters are associated with bone density and fracture incidence has not been studied. Furthermore, whether these associations are influenced by antihypertensive usage is unknown. Design and method: Prospective analysis of CARTaGENE, a cohort of individuals between 40 and 69 years old from Quebec (Canada) recruited between 2009 and 2010 (n = 20,007). Individuals with available bone density and arterial parameters are included. Peripheral blood pressure is measured using an Omron HEM-907XL sphygmomanometer and central arterial parameters using a Sphygmocor SCOR-Px. Bone density at baseline is measured using calcaneal quantitative ultrasound and incidence of fracture is identified through administrative databases from recruitment to 2016 using previously validated algorithms. Linear and Cox regression models adjusted for demographics, comorbidities and medication are used to evaluate the association between arterial parameters, bone density and fracture. The effect of antihypertensive drugs is assessed using interaction terms. Results: We included 17,118 individuals (52% women, mean age 54 years, 22% using antihypertensive medication). Mean peripheral arterial pressure is 124/74 mmHg. 721 individuals had a fracture during a median follow-up of 6.6 years. After adjustment, increases in systolic and diastolic peripheral pressures were associated with decreased bone density in individuals without antihypertensive usage while these parameters had an inverse U-shaped relation with bone density in individuals using antihypertensives. In individuals without or with antihypertensive usage, increased augmentation index (AIx), decreased pulse pressure amplification (PPA) and decreased subendocardial viability ratio (SEVR) were associated with lower bone density. In individuals using antihypertensive medication, decreased PPA and SEVR were associated with higher fracture while increased AIx is associated with lower fracture. In individuals without antihypertensive usage, these central parameters were not associated with fracture. Conclusions: In this large cohort, after adjustment for fracture risk factors, our analysis shows that peripheral and central BP parameters were associated with lower BMD in individuals without antihypertensive drugs. In individuals using antihypertensive drugs, central arterial parameters were more consistently associated with bone density and fractures. These findings highlight the relation between vascular and bone health.