AAC, PVFx Help Predict Risk of Osteoporosis-Related, Other Fractures in Men

John T. Schousboe, MD, PhD,

New research from the University of Minnesota is providing clinicians with further insight into factors that can help predict fracture risk in men.

Often overlooked due to the greater prevalence of osteoporosis in women, the new study suggests including measurements of abdominal aortic calcification (AAC) and prevalent vertebral fractures (PVFx) could improve clinicians' ability to predict which men were most likely to suffer a hip or other fractures.

"Both abdominal aortic calcification and a prevalent vertebral fracture can be simultaneously and quickly detected on standard radiographs or lateral spine bone density images, and this may aid fracture risk assessment in older men who have either or both risk factors," said lead author John T. Schousboe, MD, PhD, of the University of Minnesota and Park Nicollet Clinic & Health Partners Institute, in a statement.

With fractures posing an immediate and significant threat to aging adults, Schousboe and an international team of investigators sought to determine how measurements of AAC and PVFx, which can be ascertained on the same lateral spine images, could help predict risk of incident fracture in men. To do so, investigators designed their study to use data obtained from the Osteoporotic Fractures in Men (MrOS) study, which included data related to 5994 community-dwelling men aged 65 years and older at 6 sites across the US.

Check out this video interview from ACR 2020 on the underdiagnosis and treatment of osteoporosis in men.

For the purpose of analysis, investigators excluded men without baseline lateral spine radiographs that were interpretable for AAC and PVFx. PVFx was evaluated using Tenant semiquantitative (SQ) criteria and AAC was scored using the Framingham 24-point scale method.

In total, 5365 patients were included in the final study cohort. Investigators noted patients excluded were older, more likely to be non-white, had lower femoral neck bone mineral density, and were more likely to have had a prior non-spine fracture when compared to men included in the study.

As part of MrOS, participants were contacted every 4 months and asked if they experienced a fracture. Self-reported fractures were then confirmed through a review of medical records. Specific fractures examined in the current analysis included h incident major osteoporotic, hip, and clinical vertebral fractures.

In analyses adjusted for traditional risk factors and competing mortality, results indicated the subdistribution hazard ratio for incident major osteoporotic fracture was 1.38 (95% CI, 1.13-1.69) among men with AAC-24 score of 2 or more alone, 1.71 (95% CI, 1.37-2.14) for men with PVFx alone, and 2.35 (95% CI, 1.75-3.16) for men with both risk factors when compared to men without PVFx and AAC-24 score of 0 or 1. Additionally, Wald tests indicated improved prediction model performance when including both AAC-24 and PVFx when compared to including only AAC-24 (chi-square=17.3; P <.001) or including only PVFx (chi-square=8.5; P=.036).

“Men with a high level of AAC and a prevalent radiographic vertebral fracture may be at high risk of these fracture outcomes and may be candidates for drug treatment to lower risk of future fractures,” wrote investigators.

This study, “Joint Associations of Prevalent Radiographic Vertebral Fracture and Abdominal Aortic Calcification With Incident Hip, Major Osteoporotic, and Clinical Vertebral Fractures,” was published in the Journal of Bone and Mineral Research.