Osteoporosis and Trabecular Bone Score in Relation to Rose Questionnaire Angina: Evidence from the Bushehr Elderly Health (BEH) Program

Abstract Osteoporosis and ischemic heart disease share several risk factors and biological pathways, but their relationship remains uncertain. We examined whether angina defined by the Rose Angina Questionnaire (RAQ) was associated with bone mineral density (BMD), osteoporosis, and trabecular bone score (TBS) in 1,989 community-dwelling adults aged ≥ 50 years participating in the Bushehr Elderly Health Program in Iran. Angina was assessed using the validated Persian RAQ. BMD was measured by dual-energy X-ray absorptiometry at the lumbar spine, femoral neck, and total hip, and TBS was derived from lumbar spine images. Multivariable logistic regression assessed associations with overall and site-specific osteoporosis and abnormal TBS. Overall, 10.2% were RAQ-positive and 27.5% had osteoporosis. RAQ positivity was not independently associated with overall osteoporosis (adjusted OR 0.98, 95% CI 0.67–1.44; P = 0.932), lumbar-spine osteoporosis, total-hip osteoporosis, or abnormal TBS. In sex-specific analyses, RAQ positivity was associated with femoral-neck osteoporosis among men (adjusted OR 2.17, 95% CI 1.07–4.38; P = 0.032), but not women. These findings do not support a generalized association between RAQ-defined angina and skeletal health. The observed sex- and site-specific association in men is hypothesis-generating and requires confirmation in prospective studies.