FRAX in conjunction with T-score predicts cardiovascular risk in older adults: a retrospective cohort bone density study from Thailand

Summary

This retrospective cohort found that osteoporosis (defined by T-score) or FRAX score is linked to a higher risk of non-fatal stroke. Additionally, a high FRAX score combined with T-score increases the risk of both major adverse cardiovascular events (MACE) and non-fatal stroke.

Purpose

This study examined the relationship between osteoporosis and major adverse cardiovascular events (MACE) in Thai older adults and evaluated the predictive capacity of the FRAX score for cardiovascular risk.

Methods

A retrospective cohort study followed 348 individuals aged 60–75 Years for over 13 years (2005–2021) after their initial bone mineral density (BMD) assessment. Osteoporosis was defined by BMD T-scores ≤ −2.5 at the lumbar spine or femoral neck, or fragility fracture. High hip fracture risk was defined as a FRAX score ≥ 3%. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke (3P-MACE). Cox proportional hazards models were used to calculate hazard ratios (HR). Statistical significance was set at p < 0.05.

Results

While overall MACE was not significantly higher in the osteoporosis group, the stroke findings were increased (adjusted HR 2.46, 95% CI 1.12–5.39, p = 0.024). Utilizing FRAX score in conjunction with T-scores (FRAX-T ≥ 3%) was independently associated with an elevated risk of 3P-MACE (adjusted HR 1.88, 95% CI 1.05–3.38, p = 0.034) as well as non-fatal stroke risk (adjusted HR 3.04, 95% CI 1.38–6.69, p = 0.006).

Conclusions

Osteoporosis demonstrates a significant association with increased stroke risk in Thai older adults. Utilizing FRAX-T may improve cardiovascular risk stratification. Further large-scale prospective studies are needed to elucidate the underlying mechanisms and establish a definitive link between osteoporosis and broader cardiovascular outcomes in this population.