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Impact of osteoporotic risk in women undergoing transcatheter aortic valve replacement

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Abstract

Low body weight and advanced age are reported to be among the best predictors of osteoporosis, and osteoporosis self-assessment tool (OST) values are calculated using a simple formula to identify postmenopausal women at increased risk of osteoporosis. In our recent study, we demonstrated an association between fractures and poor outcomes in postmenopausal women following transcatheter aortic valve replacement (TAVR). In this study, we aimed to investigate the osteoporotic risk in women with severe aortic stenosis and determined whether an OST could predict all-cause mortality following TAVR. The study population comprised 619 women who underwent TAVR. Compared to a quarter of patients with diagnosis of osteoporosis, 92.4% of participants were at high risk of osteoporosis based on OST criteria. When divided into tertiles based on OST values, patients in tertile 1 (lowest OST) displayed increased frailty, a higher incidence of multiple fractures, and greater Society of Thoracic Surgeons scores. Estimated all-cause mortality survival rates 3 years post-TAVR were 84.2 ± 3.0%, 89.5 ± 2.6%, and 96.9 ± 1.7% for OST tertiles 1, 2, and 3, respectively (p = 0.001). Multivariate analysis showed that the OST tertile 3 was associated with decreased risk of all-cause mortality compared with OST tertile 1 as the referent. Notably, a history of osteoporosis was not associated with all-cause mortality. Patients with high osteoporotic risk are highly prevalent among those with aortic stenosis according to the OST criteria. OST value is a useful marker for predicting all-cause mortality in patients undergoing TAVR.

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Abbreviations

ADL:

Activity of daily living

AS:

Aortic stenosis

CT:

Computed tomography

NT-pro-BNP:

N-terminal-pro-brain natriuretic peptide

OST:

Osteoporosis self-assessment tool

STS:

Society of Thoracic Surgeons

TAVR:

Transcatheter aortic valve replacement

References

  1. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. 1993;94:646–50.

  2. Curry SJ, Krist AH, Owens DK, et al. Screening for osteoporosis to prevent fractures: US preventive services task force recommendation statement. JAMA. 2018;319:2521–31.

    Article  PubMed  Google Scholar 

  3. Siris ES, Miller PD, Barrett-Connor E, et al. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA. 2001;286:2815–22.

    Article  CAS  PubMed  Google Scholar 

  4. Koh LKH, Sedrine WB, Torralba TP, et al. A simple tool to identify Asian women at increased risk of osteoporosis. Osteoporos Int. 2001;12:699–705.

    Article  CAS  PubMed  Google Scholar 

  5. Dargent-Molina P, Poitiers F, Breart G. In elderly women weight is the best predictor of a very low bone mineral density: evidence from the EPIDOS study. Osteoporos Int. 2000;11:881–8.

    Article  CAS  PubMed  Google Scholar 

  6. Chang AJ, Ying Q, Chen XN, Wang WM, Chen N. Evaluation of three risk assessment tools in discriminating fracture status among Chinese patients undergoing hemodialysis. Osteoporos Int. 2016;27:3599–606.

    Article  PubMed  Google Scholar 

  7. Logan S, Thu WPP, Lay WK, Wang LY, Cauley JA, Yong EL. Chronic joint pain and handgrip strength correlates with osteoporosis in mid-life women: a Singaporean cohort. Osteoporos Int. 2017;28:2633–43.

    Article  CAS  PubMed  Google Scholar 

  8. Subramaniam S, Chan CY, Soelaiman IN, et al. The performance of osteoporosis self-assessment tool for Asians (OSTA) in identifying the risk of osteoporosis among Malaysian population aged 40 years and above. Arch Osteoporos. 2019;14:117.

    Article  PubMed  Google Scholar 

  9. Leon MB, Smith CR, Mack M, et al. Transcatheter aortic valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597–607.

    Article  CAS  PubMed  Google Scholar 

  10. Mack MJ, Brennan JM, Brindis R, et al. Outcomes following transcatheter aortic valve replacement in the United States. JAMA. 2013;310:2069–77.

    Article  CAS  PubMed  Google Scholar 

  11. Yoon SH, Ahn JM, Hayashida K, et al. Clinical outcomes following transcatheter aortic valve replacement in Asian population. JACC Cardiovasc Interv. 2016;9:926–33.

    Article  PubMed  Google Scholar 

  12. Saji M, Higuchi R, Izumi Y, et al. Prevalence and impact of fracture on postmenopausal women with aortic stenosis who underwent transcatheter aortic valve replacement. Cardiovasc Interv Ther. 2022;37:543–8.

    Article  CAS  PubMed  Google Scholar 

  13. Chieffo A, Petronio AS, Mehilli J, et al. Acute and 30-day outcomes in women after TAVR: results from the WIN-TAVI (Women’s INternational Transcatheter Aortic Valve Implantation) Real-World Registry. JACC Cardiovasc Interv. 2016;9:1589–600.

    Article  PubMed  Google Scholar 

  14. Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Am Coll Cardiol. 2012;60:1438–54.

    Article  PubMed  Google Scholar 

  15. Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet. 2019;393:364–76.

    Article  CAS  PubMed  Google Scholar 

  16. Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008;9:385–97.

    Article  Google Scholar 

  17. Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8:1137–48.

    Article  CAS  PubMed  Google Scholar 

  18. Crandall CJ, Ensrud KE. Osteoporosis screening in younger postmenopausal women. JAMA. 2020;323:367–8.

    Article  PubMed  Google Scholar 

  19. Shimura T, Yamamoto M, Kano S, et al. Impact of the clinical frailty scale on outcomes after transcatheter aortic valve replacement. Circulation. 2017;135:2013–24.

    Article  PubMed  Google Scholar 

  20. Ensrud KE, Thompson DE, Cauley JA, et al. Prevalent vertebral deformities predict mortality and hospitalisation in older women with low bone mass. J Am Geriatr Soc. 2000;48:241–9.

    Article  CAS  PubMed  Google Scholar 

  21. Sin DD, Man JP, Man SFP. The risk of osteoporosis in Caucasian men and women with obstructive airways disease. Am J Med. 2003;114:10–4.

    Article  PubMed  Google Scholar 

  22. Ensrud KE, Lui LY, Taylor BC, et al. Renal function and risk of hip and vertebral fractures in older women. Arch Intern Med. 2007;167:133–9.

    Article  PubMed  Google Scholar 

  23. Rodríguez-Gómez I, Mañas A, Losa-Reyna J, et al. Prospective Changes in the distribution of movement behaviors are associated with bone health in the elderly according to variations in their frailty levels. J Bone Miner Res. 2020;35:1236–45.

    Article  PubMed  Google Scholar 

  24. Arnold SV, O’Brien SM, Vemulapalli S, et al. Inclusion of functional status measures in the risk adjustment of 30-day mortality after transcatheter aortic valve replacement: a report from the Society of Thoracic Surgeons/American College of Cardiology TVT Registry. JACC Cardiovasc Interv. 2018;11:581–9.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sergi G, Veronese N, Fontana L, et al. Pre-frailty and risk of cardiovascular disease in elderly men and women: the Pro. VA study. J Am Coll Cardiol. 2015;65:976–83.

    Article  PubMed  Google Scholar 

  26. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359:1761–7.

    Article  PubMed  Google Scholar 

  27. U.S. Preventive Services Task Force. Screening for osteoporosis: U.S. preventive services task force recommendation statement. Ann Intern Med. 2011;154:356–64.

    Article  Google Scholar 

  28. Greco EA, Pietschmann P, Migliaccio S. Osteoporosis and sarcopenia increase frailty syndrome in the elderly. Front Endocrinol. 2019;10:255.

    Article  Google Scholar 

  29. Hjortnaes J, Butcher J, Figueiredo JL, et al. Arterial and aortic valve calcification inversely correlates with osteoporotic bone remodelling: a role for inflammation. Eur Heart J. 2010;31:1975–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This study was supported by a research grant from the Sakakibara Heart Foundation.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Otaku, Tokyo, 143-8541, Japan

    Mike Saji & Takanori Ikeda

  2. Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan

    Mike Saji, Mamoru Nanasato, Ryosuke Higuchi, Yuki Izumi, Itaru Takamisawa, Nobuo Iguchi & Morimasa Takayama

  3. Department of Anesthesiology, Sakakibara Heart Institute, Tokyo, Japan

    Jun Shimizu

  4. Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan

    Tomoki Shimokawa

  5. Sakakibara Heart Institute, Tokyo, Japan

    Mitsuaki Isobe

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  1. Mike Saji
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All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Corresponding author

Correspondence to Mike Saji.

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Conflict of interest

Dr. Isobe received honoraria from Daiichi Sankyo, Chugai Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., and Pfizer. Dr. Takamisawa is a proctor of the Medtronic and Edwards Lifesciences. Dr. Saji received consultant fees from Abbott Medical and Medtronic, Japan. The authors declare that they have no conflicts of interest.

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Saji, M., Nanasato, M., Higuchi, R. et al. Impact of osteoporotic risk in women undergoing transcatheter aortic valve replacement. Cardiovasc Interv and Ther 39, 57–64 (2024). https://doi.org/10.1007/s12928-023-00940-z

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  • DOI: https://doi.org/10.1007/s12928-023-00940-z

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