The purpose of this study was to compare the vascular calcification in thoracic aorta (TAC), abdominal aorta (AAC), iliac arteries (IAC), and femoral arteries (FAC) and bone mineral density (BMD) of the lumbar vertebrae between frail and robust nonagenarians, as well as to verify the associations between vascular calcification with BMD, muscle tissue quality, and quantity in both groups. Forty-two elderly subjects participated in this study: 29 institutionalized frail (92.0 ± 3.2 years) and 13 robust (89.0 ± 4.0 years) elderly participants. All patients underwent nonenhanced helical thoracic, abdominal, and thigh computed tomography. The frail group presented significantly greater FAC as well as less lumbar BMD than the robust group (p < 0.05). In the frail group, significant negative relationships were observed between the individual values of FAC with the individual values of BMD (r = −0.35 to −0.43, p < 0.05) and with the individual values of the quadriceps muscle quantity and quality (r = −0.52, p < 0.01), whereas no significant relationships were observed in the robust group. The robust group presented less vascular calcification and more BMD in the vertebral bodies than the frail group. In the frail group, femoral artery calcification was significantly negatively correlated with BMD, leg muscle quality, and muscle mass volume.
Get full access to this article
View all access options for this article.
References
1.
Rodríguez MañasL, FéartC, MannG, ViñaJ, ChatterjiS, Chodzko-ZajkoW, Gonzalez-Colaço HarmandM, BergmanH, CarcaillonL, NicholsonC, ScuteriA, SinclairA, PelaezM, Van der CammenT, BelandF, BickenbachJ, DelamarcheP, FerrucciL, FriedLP, Gutiérrez-RobledoLM, RockwoodK, Rodríguez ArtalejoF, ServiddioG, VegaE; on behalf of the FOD-CC group. Searching for an operational definition of frailty: A Delphi method based consensus statement. The frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci, 2012; 68:62–67.
MartinikorenaI, Martínez-RamírezA, GómezM, LecumberriP, Casas-HerreroA, CadoreEL, MillorN, Zambom-FerraresiF, IdoateF, IzquierdoM. Gait variability related to muscle quality and muscle power output in frail nonagenarian older adults. J Am Med Dir Assoc, 2015; 17:162–167.
4.
FriedLP, TangenCM, WaltsonJ, NewmanAB, HirschC, GottdienerJ, SeemanT, TracyR, KopWJ, BurkeG, McBurnieMA. Cardiovascular health study collaborative research group. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001; 56:146–155.
5.
EdwardsMH, DennisonEM, Aihie SayerA, FieldingR, CooperC. Osteoporosis and sarcopenia in older age. Bone, 2015; 80:126–130.
6.
AllisonMA, HsiS, WasselCL, MorganC, IxJH, WrightCM, CriquiMH. Calcified atherosclerosis in different vascular beds and the risk of mortality. Arterioscler Thromb Vasc Biol, 2012; 32:140–146.
7.
WilsonPW, KauppilaLI, O'DonnellCJ, KielDP, HannanM, PolakJM, CupplesLA. Abdominal aortic calcific deposits are an important predictor of vascular morbidity and mortality. Circulation, 2001; 103:1529–1534.
8.
ChuangML, MassaroJM, LevitzkyYS, FoxCS, MandersES, HoffmannU, O'DonnellCJ. Prevalence and distribution of abdominal aortic calcium by gender and age group in a community-based cohort (from the Framingham Heart Study). Am J Cardiol, 2012; 110:891–896.
9.
van StaaTP, DennisonEM, LeufkensHG, CooperC. Epidemiology of fractures in England and Wales. Bone, 2001; 29:517–522.
10.
PatelHP, SyddallHE, JamesonK, RobinsonS, DenisonH, RobertsHC, EdwardsM, DennisonE, CooperC, Aihie SayerA. Prevalence of sarcopenia in community-dwelling older people in the UK using the European Working Group on Sarcopenia in Older People (EWGSOP) definition: Findings from the Hertfordshire Cohort Study (HCS). Age Ageing, 2013; 42:378–384.
11.
HernlundE, SvedbomA, IvergardM, CompstonJ, CooperC, StenmarkJ, McCloskeyEV, JönssonB, KanisJA. Osteoporosis in the European Union: Medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos, 2013; 8:136.
12.
EdwardsM, GregsonC, PatelH, JamesonKA, HarveyNC, SayerAA, DennisonEM, CooperC. Muscle size, strength and physical performance and their associations with bone structure in the Hertfordshire Cohort Study. J Bone Miner Res, 2013; 28:2295–2304.
13.
FrankAW, LorbergsAL, ChilibeckPD, FarthingJP, KontulainenSA. Muscle cross sectional area and grip torque contraction types are similarly related to pQCT derived bone strength indices in the radii of older healthy adults. J Musculoskelet Neuronal Interact, 2010; 10:136–141.
14.
HughesVA, FronteraWR, DallalGE, LutzKJ, FisherEC, EvansWJ. Muscle strength and body composition: Associations with bone density in older subjects. Med Sci Sports Exerc. 1995; 27:967–974.
15.
DixonAK, LawrenceJP, MitchellJR. Age-related changes in the abdominal aorta shown by computed tomography. Clin Radiol, 1984; 35:33–37.
16.
SinnottB, SyedI, SevrukovA, BarengoltsE. Coronary calcification and osteoporosis in men and postmenopausal women are independent processes associated with aging. Calcif Tissue Int, 2006; 78:195–202.
17.
ShafferJR, KammererCM, RainwaterDL, O'LearyDH, BruderJM, BauerRL, MitchellBD. Decreased bone mineral density is correlated with increased subclinical atherosclerosis in older, but not younger, Mexican American women and men: The San Antonio Family Osteoporosis Study. Calcif Tissue Int, 2007; 81:430–441.
18.
DrinkaPJ, BauwensSF, DeSmetAA. Lack of correlation between aortic calcification and bone density. Wis Med J, 1992; 91:299–301.
19.
KielDP, KauppilaLI, CupplesLA, HannanMT, O'DonnellCJ, WilsonPW. Bone loss and the progression of abdominal aortic calcification over a 25 year period: The Framingham Heart Study. Calcif Tissue Int, 2001; 68:271–276.
20.
BaggerYZ, TankóLB, AlexandersenP, QinG, ChristiansenC. Radiographic measure of aorta calcification is a site-specific predictor of bone loss and fracture risk at the hip. J Intern Med, 2006; 259:598–605.
21.
HyderJA, AllisonMA, WongN, PapaA, LangTF, SirlinC, GapsturSM, OuyangP, CarrJJ, CriquiMH. Association of coronary artery and aortic calcium with lumbar bone density: The MESA Abdominal Aortic Calcium Study. Am J Epidemiol, 2009; 169:186–194.
22.
SzulcP, BlackwellT, KielDP, SchousboeJT, CauleyJ, HillierT, HochbergM, RodondiN, TaylorBC, BlackD, CummingsS, EnsrudKE; Study of Osteoporotic Fractures (SOF) Research Group. Abdominal aortic calcification and risk of fracture among older women—The SOF study. Bone, 2015; 81:16–23.
23.
BrownerWS, SeeleyDG, VogtTM, CummingsSR. Non-trauma mortality in elderly women with low bone mineral density. Study of Osteoporotic Fractures Research Group. Lancet, 1991; 338:355–358.
24.
TankoLB, BaggerYZ, ChristiansenC. Low bone mineral density in the hip as a marker of advanced atherosclerosis in elderly women. Calcif Tissue Int, 2003; 73:15–20.
25.
SchulzE, ArfaiK, LiuX, SayreJ, GilsanzV. Aortic calcification and the risk of osteoporosis and fractures. J Clin Endocrinol Metab, 2004; 89:4246–4253.
26.
KimKJ, KimKM, ParkKH, ChoiHS, RheeY, LeeYH, ChaBS, KimMJ, OhSM, BrownJK, LimSK. Aortic calcification and bone metabolism: The relationship between aortic calcification, BMD, vertebral fracture, 25 hydroxyvitamin D, and osteocalcin. Calcif Tissue Int, 2012; 91:370–378.
27.
SimonSP, FodorD, MunteanL, PoantaL, CristeaP, RednicS. Bone mineral density, vertebral fractures and body mass index in postmenopausal women with abdominal aortic calcification. Endocr Res, 2014; 39:1–6.
28.
SamelsonEJ, CupplesLA, BroeKE, HannanMT, O'DonnellCJ, KielDP. Vascular calcification in middle age and long-term risk of hip fracture: The Framingham Study. J Bone Miner Res, 2007; 22:1449–1454.
29.
FliponE, LiabeufS, FardelloneP, MentaverriR, RyckelynckT, GradosF, KamelS, MassyZA, Dargent-MolinaP, BrazierM. Is vascular calcification associated with bone mineral density and osteoporotic fractures in ambulatory, elderly women?. Osteoporos Int, 2012; 23:1533–1539.
30.
LangT, CauleyJA, TylavskyF. Computed tomographic measurements of thigh muscle cross-sectional area and attenuation coefficient predict hip fracture: The health, aging, and body composition study. J Bone Miner Res, 2010; 25:513–519.
31.
ShenW, PunyanityaM, WangZ, GallagherD, St-OngeMP, AlbuJ, HeymsfieldSB, HeshkaS. Total body skeletal muscle and adipose tissue volumes: Estimation from a single abdominal cross-sectional image. J Appl Physiol, 2004; 97:2333–2338.
32.
LeeSJ, JanssenI, HeymsfieldSB, RossR. Relation between whole-body and regional measures of human skeletal muscle. Am J Clin Nutr, 2004; 80:1215–1221.
33.
EisenA, TenenbaumA, Koren-MoragN, TanneD, ShemeshJ, ImazioM, FismanEZ, MotroM, SchwammenthalE, AdlerY. Calcification of the thoracic aorta as detected by spiral computed tomography among stable angina pectoris patients: Association with cardiovascular events and death. Circulation, 2008; 118:1328–1334.
34.
JenskyNE, CriquiMH, WrightCM, WasselCL, AlcarazJE, AllisonMA. The association between abdominal body composition and vascular calcification. Obesity (Silver Spring), 2011; 19:2418–2424.
35.
IsgumI, RuttenA, ProkopM, StaringM, KleinS, PluimJP, ViergeverMA, van GinnekenB. Automated aortic calcium scoring on low-dose chest computed tomography. Med Phys, 2010; 37:714–723.
36.
PickhardtPJ, PoolerDB, LauderT, del RioAM, BruceRJ, BinkleyN. Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med, 2013; 158:588–595.
37.
RossR. Advances in the application of imaging methods in applied and clinical physiology. Act Diabetol, 2003; 40:45–50.
38.
CadoreEL, Casas-HerreroA, Zambom-FerraresiF, IdoateF, MillorN, GómezM, Rodriguez-MañasL, IzquierdoM. Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians. Age (Dordr), 2014; 36:773–785.
39.
KälschH, LehmannN, MöhlenkampS, HammerC, MahabadiAA, MoebusS, SchmermundA, StangA, BauerM, JöckelKH, ErbelR; Investigator Group of the Heinz Nixdorf Recall Study. Prevalence of thoracic aortic calcification and its relationship to cardiovascular risk factors and coronary calcification in an unselected population-based cohort: The Heinz Nixdorf Recall Study. Int J Cardiovasc Imag, 2013; 29:207–216.
40.
MazurekT, ZhangL, ZalewskiA, MannionJD, DiehlJT, ArafatH, Sarov-BlatL, O'BrienS, KeiperEA, JohnsonAG, MartinJ, GoldsteinBJ, ShiY. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation, 2003; 108:2460–2466.
41.
Casas-HerreroA, CadoreEL, Zambom-FerraresiF, IdoateF, MillorN, Martínez-RamirezA, GómezM, Rodriguez-MañasL, MarcellánT, de GordoaAR, MarquesMC, IzquierdoM. Functional capacity, muscle fat infiltration, power output, and cognitive impairment in institutionalized frail oldest old. Rejuvenation Res, 2013; 16:396–403.
42.
LeischikR, FoshagP, StrauβM, GargP, DworrakB, LittwitzH, LazicJS, HorlitzM. Physical activity, cardiorespiratory fitness and carotid intima thickness: Sedentary occupation as risk factor for atherosclerosis and obesity. Eur Rev Pharmacol Sci, 2015; 19:3157–3168.
43.
MorieM, ReidKF, MiciekR, LajevardiN, ChoongK, KrasnoffJB, StorerTW, FieldingRA, BhasinS, LebrasseurNK. Habitual physical activity levels are associated with performance in measures of physical function and mobility in older men. J Am Geriatr Soc, 2010; 58:1727–1733.
44.
Rodriguez-MañasL, FriedLP. Frailty in the clinical scenario. Lancet, 2015; 385:e7–e9.
45.
KimJH, ChoiSH, LimS, LimJY, KimKW, ParkKS, ShinCS, JangHC. Thigh muscle attenuation measured by computed tomography was associated with the risk of low bone density in community-dwelling elderly population. Clin Endocrinol (Oxf), 2013; 78:512–517.
