Low bone mineral density (BMD) may increase the risk for major adverse cardiovascular events and progression of coronary artery calcification among patients with predialysis chronic kidney disease (CKD), new study findings suggest.

In a prospective cohort study that included 1957 patients with predialysis CKD, the lowest tertile of total hip BMD was significantly associated with a nearly 2.2-fold increased risk for major adverse cardiovascular events (MACE) compared with the highest tertile after adjusting for age, sex, smoking, diabetes, systolic blood pressure, and other potential confounders, Hyoungnae Kim, MD, of Soonchunhyang University Seoul Hospital in Seoul, Korea, and colleagues reported in the Clinical Kidney Journal. The investigators also found the association of MACE with BMD at the femur neck, but not with BMD at the lumbar spine.

In a subgroup of 977 patients with repeat measurements of coronary artery calcification (CAC) at year 4 of the study, higher total hip BMD was significantly associated with 25% decreased odds for CAC progression.

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Baseline CAC scores of 100 to 400 and higher than 400 were significantly associated with 3.0-fold and 5.9-fold increased risks for MACE compared with no CAC at baseline, according to the investigators.

Dr Kim and colleagues measured BMD using dual-energy X-ray absorptiometry and CAC using coronary computed tomography scans. MACE occurred in 115 patients during a median follow-up of 4.2 years.

With regard to study limitations, the authors acknowledged that they did not take into account concomitant use of steroid and bisphosphonates. They also pointed out that the study was conducted at multiple centers, suggesting the possibility of inter-center variability.


Kim H, Lee J, Lee KB, et al. Low bone mineral density is associated with coronary arterial calcification progression and incident cardiovascular events in patients with chronic kidney disease. Clin Kidney J. Published online July 21, 2021. doi:10.1093/ckj/sfab138