Bridging the diagnostic gap: coronary calcium and osteoporosis.

Abstract

Introduction: Subclinical atherosclerosis measured by coronary artery calcium (CAC) and osteoporosis often co-exist as indolent 'silent' conditions, remain underdiagnosed and undertreated, and are associated with significant morbidity and mortality. Bone density can be obtained accurately from non-contrast CAC scans, allowing for 'opportunistic' screening of OP without the need for additional tests or radiation, and thereby enhancing the yield of CAC scans and improving patient care globally.

Areas covered: This review will seek to highlight the significant relationship between osteoporosis and sub- clinical atherosclerosis. We also highlight the role of opportunistic measurements of bone mineral density (BMD) to accurately detect osteoporosis and osteopenia in CAC scans, without the need for additional radiation, tests, or financial burden.

Expert opinion: Osteoporosis is a major health problem, associated with significant morbidity and mortality, yet the condition remains under recognized, under diagnosed and undertreated. CT measurement of bone density is likely superior to BMD measures by DEXA, for fracture prediction. A link between CAC and osteoporosis beyond aging alone highlights the potential role of 'opportunistic screening' by non-enhanced CAC scans for early detection of osteoporosis and subclinical atherosclerosis simultaneously.