Association between bone mineral density and coronary artery calcification: an updated systematic review and meta-analysis.
- 2026-03-07
- BMC cardiovascular disorders 26(1)
- PubMed: 41792657
- DOI: 10.1186/s12872-026-05685-0
Study Design
- Type
- Meta-Analysis
- Sample size
- n = 40
- Population
- 23,040 participants from 21 observational studies
- Methods
- Systematic review and meta-analysis following PRISMA guidelines, searching PubMed, EMBASE, and Scopus through September 2025 for observational studies
BACKGROUND: Bone mineral density (BMD) decline and coronary artery calcification (CAC) are two age-related processes that represent major public health concerns worldwide. However, evidence regarding their association has remains uncertain despite extensive investigation. METHODS: An updated systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed, EMBASE, and Scopus were searched through September 2025 for observational studies evaluating BMD (DXA, CT, or QCT) in relation to CAC (Agatston score or equivalent). Only multivariable-adjusted effect estimates were included. Fixed-effects or Random-effects models were used to pool odds ratios (ORs) or regression coefficients. Heterogeneity was quantified with Cochran’s Q and I². Meta-regression was performed to identify study-level modifiers, and publication bias was evaluated using funnel plots, Egger’s test, and trim-and-fill. Sensitivity analyses used a leave-one-out approach. RESULTS: Twenty-one studies involving 23,040 participants were included. Categorical low BMD was associated with significantly higher odds of CAC (pooled OR 2.01, 95% CI 1.43–2.83; I² = 66.9%), which remained significant after trim-and-fill correction (OR 1.59, 95% CI 1.21–2.09). Continuous BMD showed no overall association with CAC (OR 1.00, 95% CI 0.95–1.05; I² = 77.0%). Subgroup analyses showed stronger associations for femoral neck BMD (OR 2.52, 95% CI 1.53–4.15) and combined hip–spine measures (OR 3.34, 95% CI 2.04–5.45). MDCT-based CAC assessment yielded consistent associations (OR 2.38, 95% CI 1.69–3.34), whereas lumbar spine BMD and CTA-based CAC exhibited greater variability. Meta-regression identified CAC imaging modality as the only significant contributor to heterogeneity. CONCLUSIONS: Osteopenia or osteoporosis is consistently associated with a substantially higher likelihood of coronary artery calcification across diverse populations and measurement settings, whereas continuous BMD shows no clear linear association. These findings highlight decreased bone density as a potential clinical indicator of elevated vascular risk and support integrating bone health into cardiovascular risk assessment.