Association between vertebral fractures and coronary artery calcification in current and former smokers in the ECLIPSE cohort

SUMMARY: In smokers and former smokers from the ECLIPSE cohort, there is an association between prevalent vertebral fractures (VFs) and coronary artery calcification (CAC). Chest CT scans provide the opportunity to evaluate VFs and CAC, which are potentially important comorbidities, each of which is amenable to effective interventions. INTRODUCTION: Prevalence of VFs among smokers and patients with chronic obstructive pulmonary disease (COPD) is high, and an association between CAC and osteoporosis has been described. We investigated the associations between VFs and CAC (expressed in Agatston score) in (former) smokers. METHODS: Current and former smokers from the ECLIPSE study (designed to determine underlying COPD progression mechanisms) were studied. Baseline Agatston score (zero (0), medium (1–400), or high (> 400)), baseline bone attenuation (BA), and prevalent and incident VFs (vertebrae T(1)–L(1)) were assessed on CT. RESULTS: A total of 586 subjects were included (mean age 59.8 ± 8.3; 62.3% men; 70.1% with COPD; 21.0% with prevalent VFs; 196 with zero, 266 with medium, and 124 with high Agatston score). Of these, 23.4% suffered incident VFs within 3 years. In multivariate models, prevalent VFs were associated with medium (1.83 [95% CI 1.01–3.30]) and with high (OR = 3.06 [1.45–6.47]) Agatston score. After adjustment for BA, prevalent VFs were still associated with high (OR = 2.47 [1.13–5.40]), but not significantly with medium Agatston score (OR = 1.57 [0.85–2.88]). Similarly, after adjustment for BA, high (OR = 2.06 [1.02–4.13]) but not medium Agatston score (OR = 1.61 [0.88–2.94]) was associated with prevalent VFs. Agatston score at baseline was not associated with short-term VF incidence. CONCLUSION: In (former) smokers, there was an association between prevalent VFs and Agatston score. Chest CT scans provide the opportunity to also evaluate for VFs and CAC, which are potentially important comorbidities, each of which is amenable to effective interventions. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00198-019-05218-w) contains supplementary material, which is available to authorized users.