Original Full Length ArticleAbdominal aortic calcification and risk of fracture among older women - The SOF study

- Women with severe abdominal aortic calcifiation (AAC) have higher risk of hip and spine fracture during 4-5 years of follow-up.
- Severe AAC was not associated with the risk of non-vertebral fracture in women.
- In elderly women, severe AAC is not associated with higher risk of major osteoporotic fracture during a 15-year follow-up.

Data concerning the link between severity of abdominal aortic calcification (AAC) and fracture risk in postmenopausal women are discordant. This association may vary by skeletal site and duration of follow-up. Our aim was to assess the association between the AAC severity and fracture risk in older women over the short- and long term. This is a case-cohort study nested in a large multicenter prospective cohort study. The association between AAC and fracture was assessed using Odds Ratios (OR) and 95% confidence intervals (95%CI) for vertebral fractures and using Hazard Risks (HR) and 95%CI for non-vertebral and hip fractures. AAC severity was evaluated from lateral spine radiographs using Kauppila's semiquantitative score. Severe AAC (AAC score 5 +) was associated with higher risk of vertebral fracture during 4 years of follow-up, after adjustment for confounders (age, BMI, walking, smoking, hip bone mineral density, prevalent vertebral fracture, systolic blood pressure, hormone replacement therapy) (OR = 2.31, 95%CI: 1.24-4.30, p < 0.01). In a similar model, severe AAC was associated with an increase in the hip fracture risk (HR = 2.88, 95%CI: 1.00-8.36, p = 0.05). AAC was not associated with the risk of any non-vertebral fracture. AAC was not associated with the fracture risk after 15 years of follow-up. In elderly women, severe AAC is associated with higher short-term risk of vertebral and hip fractures, but not with the long-term risk of these fractures. There is no association between AAC and risk of non-vertebral-non-hip fracture in older women. Our findings lend further support to the hypothesis that AAC and skeletal fragility are related.