Bone mineral density and incidence of stroke: European Prospective Investigation into Caner-Norfolk population-based study, systematic review and meta-analysis

European Prospective Investigation into Cancer - Norfolk population–based study, systematic review, and meta-analysis

Phyo Kyaw Myint, Allan B Clark, Chun Shing Kwok, Yoon Kong Loke, Jessica Ka-Yan Yeong, Robert N Luben, Nicholas J Wareham, Kay-Tee Khaw

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Abstract

BACKGROUND AND PURPOSE: The prospective link between osteoporosis and future risk of stroke requires evidence from large-scale population-based long-term studies.

METHODS: Calcaneum broadband ultrasound attenuation was measured in the Norfolk cohort of the European Prospective Investigation into Cancer-Norfolk between 1997 and 2000. Incident strokes were ascertained by hospital record linkage and death certificates in March 2009 and December 2011, respectively. A search of MEDLINE and EMBASE was performed to evaluate the relationship between bone mineral density and incident stroke. After data extraction of relevant studies, pooled risk of stroke was estimated using meta-analysis.

RESULTS: In 14 290 participants (mean follow-up of 9.3 years; total person-years 132 574), there were 599 incident strokes. Participants in the lowest 10% of the calcaneum broadband ultrasound attenuation distribution had an increased stroke risk (hazard ratio 1.41; 95% confidence intervals, 1.02-1.94) compared with those in the top 30% of the distribution after adjustments. A decrease of ~1 standard deviation in broadband ultrasound attenuation (20 db/MHz) was associated with a 17% increase in relative risk of stroke (95% confidence intervals, 5%-30%). Meta-analysis of 4 studies (25 760 participants, 1237 cases of stroke) found that for every decrease in 1 standard deviation in bone mineral density, there was an increased risk of incident stroke among women (pooled relative risk 1.22; 95% confidence intervals, 1.09-1.37; I2=0%, 3 studies) but not in men (pooled relative risk 1.05; 95% confidence intervals, 0.94-1.17; I(2)=0%, 2 studies).

CONCLUSIONS: Bone mineral density predicts total stroke risk. The evidence is stronger in women with regard to the continuous relationship.
Original languageEnglish
Pages (from-to)373-382
Number of pages10
JournalStroke
Volume45
Issue number2
Early online date7 Jan 2014
DOIs
Publication statusPublished - Feb 2014

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Bone Density
Meta-Analysis
Stroke
Incidence
Population
Neoplasms
Confidence Intervals
Death Certificates
Hospital Records
MEDLINE
Osteoporosis
Odds Ratio

Keywords

  • bone density
  • epidemiology
  • osteoporosis
  • risk factors
  • stroke

Cite this

Bone mineral density and incidence of stroke: European Prospective Investigation into Caner-Norfolk population-based study, systematic review and meta-analysis : European Prospective Investigation into Cancer - Norfolk population–based study, systematic review, and meta-analysis. / Myint, Phyo Kyaw; Clark, Allan B; Kwok, Chun Shing; Loke, Yoon Kong; Yeong, Jessica Ka-Yan; Luben, Robert N; Wareham, Nicholas J; Khaw, Kay-Tee.

In: Stroke, Vol. 45, No. 2, 02.2014, p. 373-382.

Research output: Contribution to journalArticle

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title = "Bone mineral density and incidence of stroke: European Prospective Investigation into Caner-Norfolk population-based study, systematic review and meta-analysis: European Prospective Investigation into Cancer - Norfolk population–based study, systematic review, and meta-analysis",
abstract = "BACKGROUND AND PURPOSE: The prospective link between osteoporosis and future risk of stroke requires evidence from large-scale population-based long-term studies.METHODS: Calcaneum broadband ultrasound attenuation was measured in the Norfolk cohort of the European Prospective Investigation into Cancer-Norfolk between 1997 and 2000. Incident strokes were ascertained by hospital record linkage and death certificates in March 2009 and December 2011, respectively. A search of MEDLINE and EMBASE was performed to evaluate the relationship between bone mineral density and incident stroke. After data extraction of relevant studies, pooled risk of stroke was estimated using meta-analysis.RESULTS: In 14 290 participants (mean follow-up of 9.3 years; total person-years 132 574), there were 599 incident strokes. Participants in the lowest 10{\%} of the calcaneum broadband ultrasound attenuation distribution had an increased stroke risk (hazard ratio 1.41; 95{\%} confidence intervals, 1.02-1.94) compared with those in the top 30{\%} of the distribution after adjustments. A decrease of ~1 standard deviation in broadband ultrasound attenuation (20 db/MHz) was associated with a 17{\%} increase in relative risk of stroke (95{\%} confidence intervals, 5{\%}-30{\%}). Meta-analysis of 4 studies (25 760 participants, 1237 cases of stroke) found that for every decrease in 1 standard deviation in bone mineral density, there was an increased risk of incident stroke among women (pooled relative risk 1.22; 95{\%} confidence intervals, 1.09-1.37; I2=0{\%}, 3 studies) but not in men (pooled relative risk 1.05; 95{\%} confidence intervals, 0.94-1.17; I(2)=0{\%}, 2 studies).CONCLUSIONS: Bone mineral density predicts total stroke risk. The evidence is stronger in women with regard to the continuous relationship.",
keywords = "bone density, epidemiology, osteoporosis, risk factors, stroke",
author = "Myint, {Phyo Kyaw} and Clark, {Allan B} and Kwok, {Chun Shing} and Loke, {Yoon Kong} and Yeong, {Jessica Ka-Yan} and Luben, {Robert N} and Wareham, {Nicholas J} and Kay-Tee Khaw",
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T1 - Bone mineral density and incidence of stroke: European Prospective Investigation into Caner-Norfolk population-based study, systematic review and meta-analysis

T2 - European Prospective Investigation into Cancer - Norfolk population–based study, systematic review, and meta-analysis

AU - Myint, Phyo Kyaw

AU - Clark, Allan B

AU - Kwok, Chun Shing

AU - Loke, Yoon Kong

AU - Yeong, Jessica Ka-Yan

AU - Luben, Robert N

AU - Wareham, Nicholas J

AU - Khaw, Kay-Tee

PY - 2014/2

Y1 - 2014/2

N2 - BACKGROUND AND PURPOSE: The prospective link between osteoporosis and future risk of stroke requires evidence from large-scale population-based long-term studies.METHODS: Calcaneum broadband ultrasound attenuation was measured in the Norfolk cohort of the European Prospective Investigation into Cancer-Norfolk between 1997 and 2000. Incident strokes were ascertained by hospital record linkage and death certificates in March 2009 and December 2011, respectively. A search of MEDLINE and EMBASE was performed to evaluate the relationship between bone mineral density and incident stroke. After data extraction of relevant studies, pooled risk of stroke was estimated using meta-analysis.RESULTS: In 14 290 participants (mean follow-up of 9.3 years; total person-years 132 574), there were 599 incident strokes. Participants in the lowest 10% of the calcaneum broadband ultrasound attenuation distribution had an increased stroke risk (hazard ratio 1.41; 95% confidence intervals, 1.02-1.94) compared with those in the top 30% of the distribution after adjustments. A decrease of ~1 standard deviation in broadband ultrasound attenuation (20 db/MHz) was associated with a 17% increase in relative risk of stroke (95% confidence intervals, 5%-30%). Meta-analysis of 4 studies (25 760 participants, 1237 cases of stroke) found that for every decrease in 1 standard deviation in bone mineral density, there was an increased risk of incident stroke among women (pooled relative risk 1.22; 95% confidence intervals, 1.09-1.37; I2=0%, 3 studies) but not in men (pooled relative risk 1.05; 95% confidence intervals, 0.94-1.17; I(2)=0%, 2 studies).CONCLUSIONS: Bone mineral density predicts total stroke risk. The evidence is stronger in women with regard to the continuous relationship.

AB - BACKGROUND AND PURPOSE: The prospective link between osteoporosis and future risk of stroke requires evidence from large-scale population-based long-term studies.METHODS: Calcaneum broadband ultrasound attenuation was measured in the Norfolk cohort of the European Prospective Investigation into Cancer-Norfolk between 1997 and 2000. Incident strokes were ascertained by hospital record linkage and death certificates in March 2009 and December 2011, respectively. A search of MEDLINE and EMBASE was performed to evaluate the relationship between bone mineral density and incident stroke. After data extraction of relevant studies, pooled risk of stroke was estimated using meta-analysis.RESULTS: In 14 290 participants (mean follow-up of 9.3 years; total person-years 132 574), there were 599 incident strokes. Participants in the lowest 10% of the calcaneum broadband ultrasound attenuation distribution had an increased stroke risk (hazard ratio 1.41; 95% confidence intervals, 1.02-1.94) compared with those in the top 30% of the distribution after adjustments. A decrease of ~1 standard deviation in broadband ultrasound attenuation (20 db/MHz) was associated with a 17% increase in relative risk of stroke (95% confidence intervals, 5%-30%). Meta-analysis of 4 studies (25 760 participants, 1237 cases of stroke) found that for every decrease in 1 standard deviation in bone mineral density, there was an increased risk of incident stroke among women (pooled relative risk 1.22; 95% confidence intervals, 1.09-1.37; I2=0%, 3 studies) but not in men (pooled relative risk 1.05; 95% confidence intervals, 0.94-1.17; I(2)=0%, 2 studies).CONCLUSIONS: Bone mineral density predicts total stroke risk. The evidence is stronger in women with regard to the continuous relationship.

KW - bone density

KW - epidemiology

KW - osteoporosis

KW - risk factors

KW - stroke

U2 - 10.1161/STROKEAHA.113.002999

DO - 10.1161/STROKEAHA.113.002999

M3 - Article

VL - 45

SP - 373

EP - 382

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 2

ER -