1046. VALOR Study Finds Much Lower Bone Mineral Density in Men with Common, Debilitating Medical Condition
DR Miller, Center for Health Quality, Outcomes, and Economic Research, Mass. Veterans Epidemiology Research & Information Center, Boston University School of Public Health, EA Krall, Boston University School of Dental Medicine, JJ Anderson, Boston University School of Medicine, S Rich, Center for Health Quality, Outcomes, and Economic Research, R Ferguson, Center for Health Quality, Outcomes, and Economic Research, L Silva, Center for Health Quality, Outcomes, and Economic Research

Objectives: Accelerated bone loss and increased risk of fracture have been associated with a number of common medical conditions in the elderly, including pulmonary, cardiac, metabolic, and gastrointestinal disorders. Generally, these associations have been studied individually. Few studies have reported on the independent and compound effects of multiple medical conditions on bone health.

Methods: This was examined in the VA Longitudinal Osteoporosis Research (VALOR) study using data from 752 male veterans over 50 years of age. Bone mineral density (BMD) at the femur and forearm were measured up to three times annually with dual energy x-ray absorptiometry (model DPX-IQ, Lunar Corp., Madison, WI). Femoral BMD measurements represent averages of right and left hips per subject. Bone stiffness at the calcaneus was measured with ultrasonography (Achilles Plus, Lunar). Annual change in BMD was computed as percent of baseline. Disease status was determined through self-report of medical diagnoses and diagnostic (ICD-9-CM) codes from the medical records. General linear modeling was used to estimate associations with various medical conditions, with adjustment for age, body mass index, physical activity, smoking, diet, and other concurrent medical conditions.

Results: Femoral BMD was significantly (p<0.05) lower (by at least 4%) in men with Crohn’s disease, rheumatoid arthritis, stroke, transient ischemic attack, congestive heart failure, or cancer. Significantly lower forearm BMD was found in men with these conditions, except for cancer, and was also found in those with diabetes, angina, or syncope. Bone stiffness was lower in men with cardiovascular disease, cancer, Crohn’s disease, or syncope. Loss of femoral BMD was also significantly greater in patients with chronic obstructive pulmonary disease. The cumulative number of medical conditions was inversely associated with all measures of BMD and bone stiffness, and the average decrement in femoral BMD with each additional condition was 0.9%. Careful examination of the modifying effects of duration of illnesses and their specific pharmacological treatments is in progress.

Conclusions: These results document the devastating and independent effects of a number of medical conditions on bone health. These include conditions, such as Crohn’s disease and rheumatoid arthritis, which are known to adversely affect bone health directly or through common treatments. However, some of the strongest effects were observed for other conditions, such as congestive heart failure and cerebrovascular disease, that often result in severe disability and immobility.

Impact: Clinicians need to be aware of the adverse effects of a number of debilitating medical conditions on bone health in older men and consider options for reducing subsequent risk of fractures.