Decreased Bone Mineral Density Is Associated with Subclinical Atherosclerosis in Asymptomatic Non-Diabetic Postmenopausal Women

<b>Background/Objectives:</b> Estrogen deficiency is strongly related to osteoporosis, but its role in the development of atherosclerotic cardiovascular disease (CVD), particularly in postmenopausal women, is unclear. The aim of this study was to assess the relationship between osteopenia and subclinical atherosclerosis in asymptomatic non-diabetic postmenopausal women. <b>Methods:</b> This prospective study included 117 consecutive postmenopausal women (mean age 59 ± 7 years) referred from the outpatient Rheumatology Clinic of the University Clinical Centre of Kosovo, recruited between September 2021 and December 2022. Clinical, biochemical, bone mineral density (BMD), carotid ultrasound and coronary CT angiography data were analyzed. Subclinical atherosclerosis was diagnosed as the presence of carotid plaques and/or increased intima-media thickness (CIMT) > 1.0 mm. <b>Results:</b> Of the 117 studied women, 83 (71%) had osteopenia or osteoporosis (T-score < -1 SD), who had higher prevalence of carotid artery plaques (27.7 vs. 8.8%, <i>p</i> = 0.019), compared to those with normal BMD. They were, also, older (<i>p</i> < 0.001), had a longer duration of menopause (<i>p</i> = 0.004) and higher CAC scores (<i>p</i> < 0.019), compared to those without plaques. In multivariate analysis [odds ratio 95% confidence interval], age [1.244 (1.052-1.470), <i>p</i> = 0.001], osteoporosis [0.197 (0.048-0.806), <i>p</i> = 0.024] and CAC score > 10 HU [0.174 (0.058-0.806), <i>p</i> = 0.006] were independently associated with the presence of carotid plaques. <b>Conclusions:</b> Reduced BMD is highly prevalent in asymptomatic non-diabetic postmenopausal women and is associated with a high prevalence of subclinical carotid atherosclerosis. Age, osteoporosis and CAC score > 10 HU were independently associated with atherosclerotic carotid plaque formation. These findings highlight the potential pathophysiological link between osteoporosis and subclinical atherosclerosis.