Association Between Bone Ultrasonometry and Cardiovascular Morbimortality: A Systematic Review and Meta-analysis.

Context: Quantitative ultrasound (QUS) can estimate bone mineral density and predict fracture risk, but its association with cardiovascular outcomes remains unclear.

Objective: We aimed to assess the associations between bone QUS parameters and cardiovascular event risk, cardiovascular mortality (CVM) and all-cause mortality (ACM).

Data sources: Pubmed, Embase, Cochrane Library databases, and grey literature were searched.

Study selection: We considered studies including people aged >40 years who reported associations between bone QUS parameters (any bone site) and our outcomes.

Data extraction: Two reviewers selected eligible studies, extracted and analyzed data, and assessed risk of bias with the Risk of Bias in Non-randomized Studies of Exposure tool. Adjusted hazard ratios (HR) with 95% confidence intervals (CIs), estimated for 1 SD reduction of QUS parameters, were pooled using random effects meta-analyses.

Data synthesis: We included 9 studies with 275 to 477 683 (median = 3244) participants (follow-up duration range 2.8-12.8 years). All studies presented associations based on calcaneal QUS parameters; only 2 reported associations with cardiovascular events with discordant results. Seven studies reported associations with CVM and 7 with ACM. Meta-analyses based on 3 studies showed that broadband ultrasound attenuation (BUA) was inversely associated with CVM (HR = 1.22, 95% CI: 1.11-1.34, I ² = 0%) and ACM (HR = 1.16, 95% CI: 1.10-1.23, I ² = 0%). Meta-analyses, based on 4 and 3 studies, respectively, showed that speed of sound (SOS) was also inversely associated with CVM (HR = 1.19, 95% CI: 1.11-1.27, I ² = 29%) and ACM (HR = 1.15, 95% CI: 1.07-1.23, I ² = 0%).

Conclusion: In a cohort of middle-aged individuals, a decrease in calcaneal BUA and SOS were both independently associated with higher cardiovascular and ACM.