Smith Cassandra, Sim Marc, Ilyas Zaid, Gilani Syed Zulqarnain, Suter David, Reid Siobhan, Monchka Barret A, Jozani Mohammed Jafari, Figtree Gemma, Schousboe John T, Lewis Joshua R, Leslie William D
Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, WA 6027, Australia.
Medical School, The University of Western Australia, WA 6009, Australia.
J Bone Miner Res. 2025 Mar 15;40(3):323-331. doi: 10.1093/jbmr/zjae208.
Vertebral fracture assessment (VFA) images from bone density machines enable the automated machine learning assessment of abdominal aortic calcification (ML-AAC), a marker of cardiovascular disease (CVD) risk. The objective of this study was to describe the risk of a major adverse cardiovascular event (MACE, from linked health records) in patients attending routine bone mineral density (BMD) testing and meeting specific criteria based on age, BMD, height loss, or glucocorticoid use have a VFA in the Manitoba BMD Registry. The cohort included 10 250 individuals (mean age 75.5 yr, 94% women without CVD) with VFA (February 2010 to March 2017). ML-AAC24 scores were categorized (low <2; moderate 2-<6; high ≥6). Over follow-up (mean 3.9 yr), 1265 people (12.3%) experienced a MACE. Among those with low, moderate, and high ML-AAC24, MACE rates per 1000 person-years were 18.4 (95% CI 16.4-20.5), 34.1 (95% CI 30.9-37.4), and 55.6 (95% CI 50.8-60.1), respectively. A similar gradient was observed after stratifying by age and sex. Incidence rate ratios (IRRs) for low vs moderate and high groups were 1.9 (95% CI 1.6-2.2) and 3.0 (95% CI 2.6-3.5), respectively. In those most likely to benefit from pharmaceutical intervention (<80 yr, not on statins), MACE rates among those with low, moderate, and high ML-AAC24 were 13.5 (95% CI 11.5-15.8), 26.0 (95% CI 22.1-30.3) and 44.1 (95% CI 37.0-52.0). Corresponding IRRs for low vs moderate 1.9 (95% CI 1.5-2.4) and high ML-AAC24 was 3.3 (95% CI 2.6-4.1]), respectively. In routine osteoporosis screening, individuals with moderate and high ML-AAC24 had substantially greater MACE rates compared to those with low ML-AAC24. Consequently, AAC detection during osteoporosis screening (especially in women) may guide intensification of preventative cardiovascular strategies.
骨密度仪的椎体骨折评估（VFA）图像可实现对腹主动脉钙化（ML-AAC）的自动化机器学习评估，腹主动脉钙化是心血管疾病（CVD）风险的一个标志物。本研究的目的是描述在曼尼托巴省骨密度登记处接受常规骨密度（BMD）检测并根据年龄、骨密度、身高降低或糖皮质激素使用情况符合特定标准且进行了VFA检查的患者发生主要不良心血管事件（MACE，来自关联的健康记录）的风险。该队列包括10250名进行了VFA检查的个体（平均年龄75.5岁，94%为无CVD的女性）（2010年2月至2017年3月）。ML-AAC24评分被分类（低＜2；中度2-＜6；高≥6）。在随访期间（平均3.9年），1265人（12.3%）发生了MACE。在ML-AAC24低、中、高组中，每1000人年的MACE发生率分别为18.4（95%CI 16.4-20.5）、34.1（95%CI 30.9-37.4）和55.6（95%CI 50.8-60.1）。按年龄和性别分层后观察到类似的梯度。低组与中、高组的发病率比（IRR）分别为1.9（95%CI 1.6-2.2）和3.0（95%CI 2.6-3.5）。在最可能从药物干预中获益的人群（＜80岁，未服用他汀类药物）中，ML-AAC24低中高组的MACE发生率分别为13.5（95%CI 11.5-15.8）、26.0（95%CI 22.1-30.3）和44.1（95%CI 37.0-52.0）。低组与中、高ML-AAC24组对应的IRR分别为1.9（95%CI 1.5-2.4）和3.3（95%CI 2.6-4.1）。在常规骨质疏松筛查中，ML-AAC24中、高组的个体发生MACE的几率显著高于ML-AAC24低组。因此，在骨质疏松筛查期间检测到AAC（尤其是在女性中）可能会指导加强预防性心血管策略。
