# Association Between Bone Ultrasonometry and Cardiovascular Morbimortality: A Systematic Review and Meta-analysis

## TL;DR

This study finds that lower bone ultrasound measurements are linked to higher risks of cardiovascular and overall mortality in middle-aged people.

## Contribution

The study provides the first meta-analysis linking bone ultrasonometry parameters to cardiovascular and all-cause mortality.

## Key findings

- Lower calcaneal broadband ultrasound attenuation (BUA) is associated with higher cardiovascular mortality.
- Reduced speed of sound (SOS) in bone ultrasound is linked to increased all-cause mortality.
- BUA and SOS showed consistent inverse associations with mortality across multiple studies.

## Abstract

Quantitative ultrasound (QUS) can estimate bone mineral density and predict fracture risk, but its association with cardiovascular outcomes remains unclear.

We aimed to assess the associations between bone QUS parameters and cardiovascular event risk, cardiovascular mortality (CVM) and all-cause mortality (ACM).

Pubmed, Embase, Cochrane Library databases, and grey literature were searched.

We considered studies including people aged >40 years who reported associations between bone QUS parameters (any bone site) and our outcomes.

Two reviewers selected eligible studies, extracted and analyzed data, and assessed risk of bias with the Risk of Bias in Non-randomized Studies of Exposure tool. Adjusted hazard ratios (HR) with 95% confidence intervals (CIs), estimated for 1 SD reduction of QUS parameters, were pooled using random effects meta-analyses.

We included 9 studies with 275 to 477 683 (median = 3244) participants (follow-up duration range 2.8-12.8 years). All studies presented associations based on calcaneal QUS parameters; only 2 reported associations with cardiovascular events with discordant results. Seven studies reported associations with CVM and 7 with ACM. Meta-analyses based on 3 studies showed that broadband ultrasound attenuation (BUA) was inversely associated with CVM (HR = 1.22, 95% CI: 1.11-1.34, I2 = 0%) and ACM (HR = 1.16, 95% CI: 1.10-1.23, I2 = 0%). Meta-analyses, based on 4 and 3 studies, respectively, showed that speed of sound (SOS) was also inversely associated with CVM (HR = 1.19, 95% CI: 1.11-1.27, I2 = 29%) and ACM (HR = 1.15, 95% CI: 1.07-1.23, I2 = 0%).

In a cohort of middle-aged individuals, a decrease in calcaneal BUA and SOS were both independently associated with higher cardiovascular and ACM.