Plenary Poster ANZBMS-MEPSA-ANZORS 2022

Introduction

Anti-resorptive medications are first-line treatments for osteoporosis. Additionally, patients with osteoporosis are at high cardiovascular risk, which may be partly due to extra-skeletal calcification such as in the coronary vessels. It is uncertain if anti-resorptive medication effects coronary calcification. We therefore measured the presence and severity of coronary stenosis in a cohort of patients with osteoporosis using anti-resorptive medications and in controls.

Methods

Individuals dispensed at least one script for an anti-resorptive medication (bisphosphonates or denosumab) at Monash Health between 2009-2022 were identified. Unique record numbers for these individuals were cross matched against the cardiac CT imaging service at Monash Heart (HREC#73603). Sex-matched controls not taking anti-resorptive medications were identified from the imaging database. Coronary calcification causing stenosis was reported using the standardised “Coronary Artery Disease - Reporting and Data System (CAD-RADS)”. Moderate-severe stenosis was defined as CAD-RADS≥4 (stenosis ≥25%).

Results

Eighty-four patients (women=68 [81%], median age =66 years [range: 57-74]) were enrolled. Seventy-four (88%) individuals had evidence of coronary stenosis. Zoledronic acid (n=13 [31%]), alendronate (n=11 [26%]) and risedronate (n=11 [26%]) were the most dispensed medications. Additionally, there were five individuals dispensed denosumab (12%) and two dispensed pamidronate (5%). The frequency of moderate-severe stenosis was comparable between groups (n=13 [31%] in anti-resorptive users versus n=15 [36%] in controls). In age and sex adjusted models, anti-resorptive use was negatively associated with CAD-RADS stenosis score (β=0.47 [0.24 to 0.92]) and was associated with reduced odds for increasing stenosis grade (0.25 [0.10 to 0.75]). Analyses were not significant when restricted to those with CAD-RADS>0.

Interpretation

In this preliminary report, we describe that anti-resorptive medication users appear to have lower coronary stenosis scores. Analysis of the full cohort, including consideration of important cardiovascular and skeletal risk factors, is needed to validate this initial finding.