Strong Heart, Strong Bones: How Cardiovascular Health Affects Bone Density

Strong Heart, Strong Bones: How Cardiovascular Health Affects Bone Density

A heart-healthy lifestyle could be the key to stronger bones. New research discovers how cardiovascular health affects bone mineral density across different age and health groups.

In a study recently published in the journalScientific reportsResearchers examined the association between the essential 8 (LE8) means of life and bone mineral density (BMD) in adults aged 20 to 59 years in various demographic and health subgroups.

background

Osteoporosis, characterized by reduced BMD, represents a significant health risk, particularly for those over 50, with over 30% of women and 20% of men at risk of fracture. Shared risk factors such as obesity, hypertension and metabolic syndrome link osteoporosis and cardiovascular disease. Emerging evidence suggests that cardiovascular health as measured by LE8 may influence BMD through mechanisms such as reduced inflammation, improved calcium metabolism, and hormonal regulation. Research into this connection could improve understanding of osteoporosis mechanisms and inform prevention and treatment strategies. Further research is important to clarify the underlying pathways and develop targeted interventions.

About the study

The present study analyzed data from the 2011–2018 National Health and Nutrition Examination Survey (NHANES). Exclusion criteria included participants younger than 20 years or older than 59, postmenopausal women (a group at high risk of osteoporosis), those with chronic diseases affecting bone metabolism, those with incomplete data, and those with fractures or osteoporosis. After exclusions, 2159 participants aged 20 to 59 years remained.

LE8, a cardiovascular health metric established by the American Heart Association, includes four health behaviors (diet, physical activity, nicotine exposure, and sleep health) and four health factors (body mass index (BMI), blood lipids, blood sugar, and blood pressure). LE8 scores ranging from 0 to 100 were calculated using validated methods. Dual-energy X-ray absorptiometry (DXA) measured BMD at multiple anatomical sites.

Covariates included demographic, lifestyle, and clinical factors such as age, race, smoking, alcohol consumption, vitamin D intake, and laboratory measurements. Analyzes were performed using R software and adjusted three models: unadjusted, adjusted for age/sex/race, and fully adjusted for socioeconomic, lifestyle, and clinical confounding factors. Statistical analyses, including weighted linear regression and subgroup analysis, assessed the relationships between LE8 scores and BMD. Results were adjusted for multiple confounders and significance was defined asP<0.05.

Study results

The Smoker's Dual Effect: LE8's nicotine exposure metric not only improves CVH, but may improve calcium absorption and may be directly linked to a known osteoporosis risk factor.

A total of 2,159 participants were enrolled in this study, with 52.15% male and a mean age of 36.61 ± 10.95 years. Participants in the high cardiovascular health (CVH) group were younger, predominantly female, and more likely to be non-Hispanic white with higher levels of education and better socioeconomic status compared to the low CVH group. They also showed lower alcohol consumption and a higher prevalence of never smokers.

Although alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were within the normal range, they were significantly higher in the high CVH group, while BMI was particularly lower. An upward trend in lumbar spine and trunk BMD was observed as CVH values ​​increased. In addition, the high CVH group had significantly fewer individuals with high blood pressure and diabetes (diabetes (P<0.05).

Weighted multivariate linear regression showed a positive association between LE8 values ​​and BMD at multiple anatomical sites. Fully adjusted models showed that LE8 values ​​were positively correlated with lumbar spine (β = 0.016,P<0.001), thoracic spine (β = 0.009,P<0.001), trunk (β = 0.013,P<0.001) and total BMD (β = 0.010,,P<0.001). The high CVH participants showed an increase of 0.042 g/cm² in lumbar spine BMD, 0.033 g/cm² in thoracic spine BMD, 0.046 g/cm² in trunk BMD and 0.049 g/cm² in total BMD compared to the low CVH group. However, no significant association was found between LE8 scores and head BMD, which the authors attributed to measurement issues unique to the cranial bone. Analyzes with smooth curve fits confirmed positive linear correlations between LE8 scores and BMD at all other sites.

Subgroup analyzes highlighted significant variations in age and BMI categories. Participants aged 20 to 34 years showed the greatest BMD increase, with each 10-point increase in LE8 scores associated with gains of 0.022 g/cm² in lumbar spine BMD, 0.012 g/cm² in thoracic spine BMD, 0.017 g/cm² in trunk BMD. and 0.013 g/cm² for total bmd (P<0.05).

In BMI-specific analyses, those in the normal BMI range (18.5-24.9) experienced greater BMD gains than underweight or overweight groups. In underweight and overweight individuals, LE8 values ​​showed no significant association with BMD. For every 10-point increase in LE8 values, normal BMI subjects achieved 0.020 g/cm² in lumbar spine BMD, 0.014 g/cm² in thoracic spine BMD, 0.021 g/cm² in trunk BMD, and 0.018 g/cm² in trunk BMD (BMD ((0.018 g/cm)).P<0.05).

Gender-specific analysis revealed a positive association between LE8 values ​​and thoracic spine bmd in women (β = 0.011,P<0.001), with no significant relationship observed in men.

Conclusions

The Hidden Role of Sleep Health: Beyond diet and exercise, the sleep component of Le8 can stabilize hormones like estrogen and provide a new angle for maintaining bone density.

This study identifies a significant positive association between LE8 score and BMD at different sites, being observed more strongly in individuals with higher CVH. Younger individuals (20-34 years) and women, particularly for BMD who are bmd of the thoracic spine, show greater benefits influenced by active bone metabolism and hormonal factors such as estrogen. The authors found that the components of LE8—as with adherence to diets such as DASH (high in calcium, low in sodium), physical activity, and smoking cessation—can improve BMD by optimizing calcium absorption, reducing oxidative stress, and stabilizing hormone levels.

Healthy behaviors reflected in LE8, including balanced diets, physical activity and optimal BMI, support both cardiovascular and bone health. These results demonstrate the potential of LE8 as a practical tool for assessing bone health and guiding personalized osteoporosis prevention strategies. However, the cross-sectional design limits causal inferences, and the exclusion of postmenopausal women limits the generalizability of this high-risk population. Future longitudinal studies are needed to confirm these results.

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