Approved research

Osteoporosis, fractures and cardiovascular risk

Lay summary

Osteoporosis (thinning of the bones), and ischaemic heart disease (narrowing of arteries in the heart) are both common conditions associated with an enormous burden of ill health and decreased survival across the population. Recent studies have suggested that people who have osteoporosis are more likely to have narrowing of their arteries and are also likely to die earlier than those who do not. However such studies have usually been small and unable to investigate potential underlying mechanisms. We will use the whole UK Biobank cohort to initially explore the relationships between baseline measures of bone density (heel ultrasound), and risk factors for heart attacks and strokes such as blood pressure, pulse wave velocity and aortic stiffness and pre-existing heart disease, whilst controlling for other factors such as coexisting disease, medications, lifestyle, physical activity and family history. We will then investigate, when the assay results become available, whether these relationships are mediated via markers of chronic inflammation and other factors such as vitamin D and sex-hormone levels. We will also request data on new cardiovascular events such that after 5 years, longitudinal associations can be explored.

Scope extension, June 2024: 

We will explore the potential to use novel epidemiological methods, using genotype data (which will become available) to establish whether changes in blood markers might actually cause increased risk of fractures or cardiovascular disease. We also request linked NHS data on new fractures and cardiovascular events such that longitudinal associations can be explored.

There is increasing evidence that early development plays a role in the establishment of the risks of cardiovascular disease and osteoporosis. In addition to exploring whether associations between bone and cardiovascular health measures are influenced by early developmental measures, we will undertake analyses investigating associations between early life measures, for example birthweight, and measures of bone/cardiovascular health.

In women, hormonal and reproductive factors are associated with both bone and cardiovascular health. We will therefore consider how such factors, together with diet and lifestyle might relate to bone or cardiovascular measures. In both men and women, factors such as comorbidities, body composition and physical function are linked to both cardiometabolic disease and musculoskeletal health. We will investigate novel measures of body composition (from MRI), together with those from DXA, indices of  muscle strength and physical function, and information on comorbid conditions (eg from questionnaire, cognitive function and blood analytes) in relation to musculoskeletal outcomes and cardiometabolic health, assessed from DXA and CMR measures together with prior and incident health events.

In a recently ESRC funded study: Understanding coverage in UK Longitudinal Population Studies, we aim to analyse two datasets of interest (BCS70 and UK Biobank) to assess coverage and representativeness at the point of recruitment and over time.  Measures of coverage and representativeness identified during the literature review stage will be applied in the analyses of these two data sources.  Suitability of different measures in different contexts will then be assessed.  In order to build statistical models to assess representativeness, it is important to have access to a wide range of demographic, socio-economic and geographical characteristics of individuals and, therefore we request access to a modest set of further variables.