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Maria Guillen-Placencia, MD – Resident, Centro Médico ABC

Jorge Valladares, MD – Fellow, ABC Medical Center

Joaquin G. Joya-Galeana, MD – Endocrinology, Endo PLus


Objective :

To establish a correlation between the FRAX score and 10-year estimated Atherosclerotic Cardiovascular Disease Risk (ASCVD) in asymptomatic males compared to females.

Methods :

Cross-sectional study in Mexico City in asymptomatic outpatients. ASCVD was calculated using the American College of Cardiology/American Heart Association formula (2013- ACC/AHA); densitometry was performed using a Hologic-Discovery device. We used current accepted cut off points for: high ASCVD ≥7.5%, FRAX for major osteoporotic factures (MOF) ≥10% and hip fracture (HF) ≥3% and adjustments for trabecular bone score (TBS).

Results :

234 patients from January 2017 to March 2018. Males and females were paired according to age and BMI. Hypertension, diabetes mellitus, smoking status were similar between the groups.  

A higher mean in males of  2013 ACC/AHA [23.4 %(CI 95%, 21-25.8) vs. 17% (14.5- 19.7),p<0.01]. Females had a higher mean in FRAX MOF than men [CI 95% (5.5 (CI 95%, 4.7-6.3)vs. 2.9 (CI 95%, 2.4-3.3), p < 0.01]. 6% of women and 4% of men had a prior fracture.ASCVD risk and FRAX-MOF had a higher correlation for females than for males [(Pearson ´r=0.492, p<0.001) vs (r=0.058, p=0.535),respectively] that increased when adjusted for TBS [(r=0.378, p<0.001) vs (r=0.100, p=0.282), respectively].

FRAX HIP had a higher correlation for females than for males and when adjusted to TBS the correlation between the groups was higher in males than females [r= (0.418, p <0.001) vs (0.259, p=0.28)].The discriminating capability of total FRAX-MOF for a previous fracture was similar for females vs. males ((AUC=0.81 (95%CI, 0.69-0.94) vs. 0.74 (95% CI 0.54-0.95), p=0.2), respectively).


Discussion :

Stronger ASCVD risk scores correlate with higher FRAX scores. The correlation is stronger in females than in males. It increases when adjusting for TBS, particularly in males. Males with ASCVD risk scores have 2.15-fold risk major osteoporotic fracture and 2.6-fold risk of hip fracture. Many pathways of this correlation have been studied showing the impact of atherosclerosis in bone microarchitecture.

Conclusion :

This study finds an association between deterioration of microarchitecture with ASCVD risk and suggest that high cardiovascular risk males should be evaluated for fracture risk.

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