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Original Investigation
October 16, 2017

Association of Bone Mineral Density With the Risk of Intracranial Aneurysm

Author Affiliations
  • 1Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
  • 2Yeongjusi Health Center, Gyeongsangbuk-do, Republic of Korea
  • 3Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
  • 4Department of Neurology, The Armed Forces Capital Hospital, Sungnam, Republic of Korea
JAMA Neurol. Published online October 16, 2017. doi:10.1001/jamaneurol.2017.3431
Key Points

Question  What is the association of bone mineral density with intracranial aneurysms?

Findings  In this cross-sectional study that included 12 785 participants, lower bone mineral density tertiles were associated with increased risk of intracranial aneurysm and larger aneurysm size. Those in the lowest tertile of bone mineral density had approximately 30% higher risk of harboring an intracranial aneurysm compared with those in the highest tertile, and patients with bone mineral density lower than normal based on T score also had a higher risk of intracranial aneurysm and large and multiple aneurysms.

Meaning  Bone mineral density may be associated with the presence, size, and multiplicity of intracranial aneurysm.

Abstract

Importance  Disruption of extracellular matrix integrity is critically involved in both intracranial aneurysm and bone fragility. Furthermore, both intracranial aneurysm and osteoporosis have a female predominance, and sex hormones are considered to affect this discrepancy.

Objective  To evaluate the association between bone mineral density and intracranial aneurysm.

Design, Setting, and Participants  A cross-sectional study conducted with 14 328 patients who underwent brain magnetic resonance angiography and bone mineral densitometry as a part of a health examination at a specialized center for comprehensive health examination in Seoul, the largest metropolitan area in the Republic of Korea, between December 2004 and November 2015. After excluding patients with insufficient clinical information (n = 1102) and with ambiguous intracranial arterial lesion (n = 441), 12 785 were included in the analysis.

Exposures  Bone mineral density was measured at the lumbar vertebrae (L1 to L4), femur neck, and total hip using dual-energy x-ray absorptiometry.

Main Outcomes and Measures  Multiple logistic regression or linear regression was used to examine the association between tertiles of bone mineral density and the presence, size, and multiplicity of intracranial aneurysms. In secondary analyses, we analyzed postmenopausal women and men 50 years and older (n = 8722) because they are particularly at risk of decreased bone mineral density.

Results  Among 12 785 patients in the study (7242 women [56.6%]; mean [SD] age, 54.8 [10.1] years) intracranial aneurysms were found in 472 patients (3.7%). Lower bone mineral density was associated with an increased risk of harboring intracranial aneurysm. In multivariable logistic regression analyses, odds ratios for the highest compared with the lowest bone mineral density tertile were 1.30 (95% CI, 1.03-1.64) in the lumbar spine, 1.30 (95% CI, 1.03-1.64) in the femoral neck, and 1.27 (95% CI, 1.01-1.60) in the total hip after adjusting for age, sex, and vascular risk factors. In a linear regression model adjusted for age, sex, and vascular risk factors, the lowest tertile of bone mineral density in the lumbar spine was associated with an increased log-transformed size of aneurysm (β, 0.196; SE, 0.047). In secondary analyses, these associations were more definite and a low T score (<−1 SD) was additionally associated with multiple aneurysms (OR, 1.84; 95% CI, 1.05-3.30) after adjusting for age, sex, and vascular risk factors.

Conclusions and Relevance  Bone mineral density may be associated with the presence, size, and multiplicity of intracranial aneurysm. The study findings provide evidence for shared pathophysiology between intracranial aneurysm and bone fragility.

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