Systematic evaluation of abdominal aortic calcification in patients with a recent clinical fracture visiting the Fracture Liaison Service

Summary: The prevalence of AAC in patients attending a Fracture Liaison Service is 27.6%. Prevalent vertebral fractures were associated with AAC, but not with severe AAC in patients without CVD. Fracture location and BMD were not related to AAC or severe AAC. Purpose: Abdominal aortic calcification (AAC) is associated with an increased risk of cardiovascular disease (CVD), osteoporosis and fractures. We aimed to analyze the prevalence and severity of AAC and to assess whether index fracture location, bone mineral density (BMD) and prevalent VFs are associated with AAC in patients with a recent fracture. Methods: Cross-sectional cohort study of patients with a recent clinical fracture (aged 50–90 years) attending the FLS. Patients received a BMD measurement and lateral spine imaging using Dual-energy X-ray absorptiometry. AAC prevalence was assessed using the AAC-24 score and categorized as none, moderate (AAC-24 1–4) and severe (AAC-24 ≥ 5). Multivariate logistic regression analyses were performed to study the association between risk factors and AAC presence/ severity. Results: AAC was present in 478 (27.6%) of 1731 patients of whom 207 (43.3%) had moderate and 271 (56.7%) severe AAC. The presence of AAC was associated with age, BMI, smoking, history of CVD and prevalent grade 2 or 3 VFs, but index fracture location and BMD were not associated with AAC or severe AAC. In patients with AAC (n = 318) without a history of CVD, there was no association between index fracture location and BMD. In that subgroup, severe AAC was not associated with prevalent VFs. Conclusions: In FLS patients, the prevalence of AAC and severe AAC was 27.6% and 15.7%. Index fracture location and BMD were not associated with AAC or severe AAC. Prevalent VFs were associated with AAC, but not with severe AAC in the subgroup of patients without CVD.