Osteoporosis and Coronary Artery Disease Burden in Older Adults with Chronic Coronary Syndrome: A Two-Center Cross-Sectional Study in Vietnam

Background/Objectives: Osteoporosis and coronary artery disease coronary artery disease (CAD) share common risk factors and biological pathways, yet their relationship in older adults with chronic coronary syndrome (CCS) remains incompletely understood. This study investigated the association between dual-energy X-ray absorptiometry (DXA)-defined osteoporosis and angiographic CAD burden in older adults with CCS. Methods: This two-center cross-sectional study included 451 consecutive adults aged ≥60 years with CCS who underwent DXA and invasive coronary angiography between July 2023 and June 2024. Osteoporosis was defined according to the World Health Organization criteria. CAD burden was assessed by disease extent (≥2-vessel or left main disease and ≥3-vessel or left main disease) and angiographic severity using the Gensini score. Multivariable logistic regression was performed after adjustment for age, sex, body mass index, hypertension, diabetes mellitus, chronic kidney disease, and smoking history. Results: Osteoporosis was identified in 151 participants (33.5%). Compared with participants without osteoporosis, those with osteoporosis had significantly higher prevalences of ≥2-vessel or left main disease (79.5% vs. 55.7%, p < 0.001), ≥3-vessel or left main disease (66.9% vs. 33.3%, p < 0.001), and severe CAD (Gensini score > 54; 29.0% vs. 15.0%, p = 0.022). After multivariable adjustment, osteoporosis remained independently associated with ≥2-vessel or left main disease (adjusted odds ratio [OR] 3.97, 95% confidence interval [CI] 2.31–6.81), ≥3-vessel or left main disease (adjusted OR 5.07, 95% CI 3.06–8.41), and severe CAD (adjusted OR 3.08, 95% CI 1.50–6.36; all p ≤ 0.002). Conclusions: DXA-defined osteoporosis was independently associated with a substantially greater angiographic burden of coronary artery disease in older adults with CCS. These findings suggest that osteoporosis may serve as a marker of more advanced coronary atherosclerosis and support closer cardiovascular risk assessment in this high-risk population.