Associations of absolute risk of osteoporotic fractures (FRAX®) and total cardiovascular risk (SCORE) in urban population of the Russian Federation

Aim. To study the distribution of mean values of absolute risk (AR) of osteoporotic fractures (OPF) and cumulative cardiovascular risk (CVR) depending on age, gender, climatic and geographical conditions, economic characteristics of the regions and assess their associations.

Material and methods. A representative sample of the urban population of the Russian Federation from 7 regions was analyzed. We included participants from following cities: Vologda, Ivanovo, Volgograd, Tyumen, Vladivostok, Vladikavkaz, Kemerovo and Krasnoyarsk. In total, 9143 espondents took part in the one-stage study: women (n=6324) and men (n=2819) aged 40-69 years. Over the next 10 years, OPF AR was calculated on the basis of the Russian FRAX® model without taking into account the bone mineral density using batch processing. To assess the total CVR, the SCORE scale was used for countries with a high risk of cardiovascular disease in people <65 years of age. To study the associations of risks with basic economic indicators characterizing the welfare of the regions: gross regional product, per capita income and compulsory medical insurance (CMI). We used the Rosstat report and official data of the territorial CMI funds for 2013.

Results. In the total sample, the average AR of the main OPF was 7,8% (8,9% in women and 5,5% of men), hip fractures — 0,7% (0,9% in women and 0,4% in men), and in women average AR was significantly higher than in men (p=0,0001). The risk of main OPF increased by 2 times to the age of 70, in men — by 1,2 times. The risk of hip fractures from 40 to 70 years increased 5,5 times in women and 4,5 times in men. There were 16% of people at high OPF risk. The average CVR in the sample of 40-64 years old was 3,2%, indicating a moderate CVR in this population. In men, CVR corresponded to a high risk (6,1%), and in women to moderate and amounted to 2,0%. In men, the CVR was significantly higher (p<0,0001) than in women and increased from 40 to 65 years old by 4,3 times, in women — 7,3 times. High and very high cumulative CVR were noted in 36% of participants. The risk of OPF did not depend on climatic and geographical factors, while the highest CVR was detected in the northernmost region (Vologda) and gradiently decreased to the south (Vladikavkaz). Both between the risk of OPF and CVR, an inverse correlation was revealed with the economic parameters of population well-being. A significant positive correlation between the risk of OPF and CVR was demonstrated.

Conclusion. The risk of fracture, determined using the FRAX® algorithm, is positively associated with cumulative CVR (SCORE) in both men and women. The contribution of the socio-economic factors of the region and the level of population well-being to the formation of both bone and cardiovascular risk is shown, while climatic and geographical features played a role only in increasing the CVR. The results suggest that improving of personal medical care will reduce the risk of complications of osteoporosis and atherosclerosis, regardless of the geography and climate of the region.

1. Boytsov SA, Samorodskaya IV. Dynamics of cardiovascular mortality among men and women in subjects of Russian Federation (2002 to 2011). Kardiologiia. 2014;54(4):4-9. (In Russ.) doi:10.18565/cardio.2014.4.4-9.

2. Lesnyak OM, Baranova IA, Belova KY, et al. Osteoporosis in Russian Federation: epidemiology, socio-medical and economical aspects (review). Traumatology and Orthopedics of Russia. 2018;24(1):155-68. (In Russ.) doi: 10.21823/2311-2905-2018-24-1-155-168.

3. Lampropolos CE, Papaioannou I, D'Cruz D. P. Osteoporosis — a risk factor for cardiovascular disease? Nat. Rev. Rheumatol. 2012;8:587-98. doi: 10.1038/nrrheum.2012.120.

4. Skripnikova IA, Abirova ES, Alikhanova NA, Kosmatova OV. Vessel stiffness, calcification and osteoporosis. Common pathogenetic components. Cardiovascular Therapy and Prevention. 2018;17(4):95-102. (In Russ.) doi:10.15829/1728-8800-2018-4-95-102.

5. Muniyappa R, Tella SH. Osteoporosis and Cardiovascular Disease in the Elderly. Conn's Handbook of Models for Human Aging. 2nd Edition. 2018. SECTION IV. Chapter 53. 721-733. doi:10.1016/B978-0-12-811353-0.00053-1.

6. Skripnikova IA, Oganov RG. Osteoporosis and cardiovascular disease (CVD) due to atherosclerosis (AS) in postmenopausal women: a commonality of behavioral and social risk factors. Osteoporosis and osteopathy. 2009;12(2):5-9. (In Russ.)

7. den Uyl D, Nurmohamed MT, van Tuyl Lilian HD, Raterman HG, Lems WF. (Sub) clinical cardiovascular disease is associated with increased bone loss and fracture risk; a systematic review of the association between cardiovascular disease and osteoporosis. Arthritis Research & Therapy. 2011;13(1):R5. doi:10.1186/ar3224.

8. Piepoli MF, Hoes AW, Agewall S, et al. ESC Scientific Document Group. European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315-81. doi:10.1093/eurheartj/ehw106.

9. Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporosis Int. 2008;19(4):385-97. doi:10.1007/s00198-007-0543-5.

10. FRAX® (WHO Fracture Risk Assessment Tool). Available at: http://www.shef.ac.uk/FRAX/tool.jsp?country=22

11. Research Organizing Committee of the ESSE-RF project. Epidemiology of cardiovascular disease in different regions of Russia (ESSE-RF). The rationale for and design of the study. The Rus. J. of Preventive Med. and Pub. Health. 2013;6:25-34. (In Russ.)

12. Clinical recommendations for the prevention and management of patients with osteoporosis. Edited by O. M. Lesnyak; Russian Association for Osteoporosis. Yaroslavl: IPK “Litera”, 2012. p.24. (In Russ.) ISBN 978-5-904729-76-9.

13. EMISS state statistics. Total regional income per capita in regions of Russian Federation. ЕМИСС. (In Russ.) https://www.fedstat.ru/indicator/42928

14. Federal Statistics Service of Russian Federation. Mean monetary income per capita in regions of Russian Federation. (In Russ.) http://www.gks.ru/wps/wcm/connect/rosstat_main/rosstat/ru/statistics/ population/level/

15. Territorial funds of mandatory state health insurance. Regional programs of free health care in regions of Russian Federation. (In Russ.) http://www.ffoms.ru/system-oms/territorial-funds/

16. Lesnyak OM, Yershova OB, Belova KYu, et al. Epidemiology of osteoporotic fractures in the Russian Federation and the Russian model of FRAX. Osteoporosis and osteopathy. 2014;3:3-8. (In Russ.)

17. Nikitinskaya OA, Toroptsova NV. Assessment of 10-year probability of osteoporotic fractures with the Russian model of FRAX® in a population-based sample 5 regions of Russia. Meditsinsky sovet J. (Medical Council). 2017; 1S: 103-7. (In Russ.) doi:10.21518/2079-701X-2017-0-103-107.

18. Kanis JA, Johnell O, De Laet C, et al. International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res. 2002;17(7):1237-44. doi:10.1359/jbmr.2002.17.7.1237.

19. Strom O, Borgstrom F, Kanis JA, et al. Osteoporosis: burden, health care provision and opportunities in the EU: A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Association (EFPIA). Arch. Osteoporos. 2011;6(1-2):59-155. doi:10.1007/s11657-011-0060-1.

20. Shalnova SA, Deev AD, Metelskaya VA, et al. Awareness and treatment specifics of statin therapy in persons with various cardiovasular risk: the study ESSE-RF. Cardiovascular Therapy and Prevention. 2016;15(4):29-37 (In Russ.) doi:10.15829/1728-8800-2016-4-29-37.

21. Mychka VB. A woman's heart. M: Moscow. 2012. p. 191. (In Russ.) ISBN 978-5-88149-543-5.

22. Skripnikova IA, Guryev AV, Shalnova SA, et al. The prevalence of clinical factors used for risk assessment of osteoporotic fractures. Preventive Medicine. 2016; 19(5):32-40. (In Russ.) doi:10.17116/profmed201619532-40.

23. Curtis EM, van der Velde R, Moon RJ, et al. Epidemiology of fractures in the United Kingdom 1988-2012: variation with age, sex, geography, ethnicity and socioeconomic status. Bone. 2016;87:19-26. doi: 10.1016/j.bone.2016.03.006.

24. Shalnova SA, Konradi AO, Karpov YuA, et al. Cardiovascular mortality in 12 Russian Federation regions — Participants of the “Cardiovascular Disease Epidemiology in Russian Regions” study. Russian Journal of Cardiology. 2012;(5):6-11. (In Russ.) doi:10.15829/1560-4071-2012-5-6-11

25. Alikhanova NA, Skripnikova IA, Tkacheva ON, et al. Association of vessel stiffness parameters and subclinical atherosclerosis and mass of bone tissue in postmenopausal women. Cardiovascular Therapy and Prevention. 2016;15(2):51-6. (In Russ). doi:10.15829/1728-8800-2016-2-51-56.

26. Makovey J, Macara M, Chen JS, et al. High osteoporotic fracture risk and CVD risk co-exist in postmenopausal women. Bone. 2013;52(1 ):120-5. doi: 10.1016/j.bone.2012.09.025.

27. Kawinska-Hamala A, Kawinski A, Stanek K, et al. Correlations between 10-year risk of death from cardiovascular diseases and 10-year osteoporotic fracture risk in postmenopausal women. Endokrynologia Polska. 2017;68(4):390-7. doi:10.5603/EP.a2017.0030.