Osteoporosis and cardiac remodeling in middle-aged and older adults: a cross-sectional study

Osteoporosis is associated with cardiovascular disease, but the relationship between bone mineral density (BMD) and cardiac structure and function remains incompletely understood. This cross-sectional study analyzed baseline data from 1233 participants (median age 60 years; 59% female) in the Osteoarthritis and Cardiovascular Health Cohort. BMD was categorized as normal (T-score ≥ - 1.0, n = 364), osteopenia (- 2.5 < T-score < - 1.0, n = 404), or osteoporosis (T-score ≤ - 2.5, n = 465). Cardiac parameters were measured via echocardiography. Multivariable linear regression adjusted for age, sex, and cardiovascular risk factors. Osteoporosis was associated with higher LAVI (median: 29 vs. 26 mL/m², P < 0.001) and RWT (0.38 vs. 0.37, P = 0.047) compared to normal BMD. After adjustment, T-score was inversely associated with LAVI (β = - 0.358, P = 0.043) and RWT (β = - 0.003, P = 0.013). Subgroup analyses showed stronger effects in women (LAVI β = - 0.737, P = 0.001) and participants < 50 years (LAVI β = - 0.909, P = 0.022). No significant associations were observed for left ventricular mass index, ejection fraction, or diastolic function metrics. Lower BMD, measured by tibial ultrasound, is independently associated with left atrial enlargement and increased ventricular wall thickness, particularly in women and younger adults. These findings suggest shared pathophysiological mechanisms between bone loss and cardiac remodeling, warranting more in-depth research.