Journal of Bone and Mineral Metabolism

, Volume 36, Issue 2, pp 229–237 | Cite as

Vitamin D status and abdominal aortic calcification in postmenopausal women

  • A. El MaghraouiEmail author
  • T. Hamza
  • S. Sadni
  • A. El Maataoui
  • A. Majjad
  • A. Rezqi
  • Z. Ouzzif
  • A. Mounach
Original Article


Vitamin D has an important role in bone metabolism and may be involved in the process of vascular calcification. The objective of this study was to evaluate the effect of vitamin D status on the presence of abdominal aortic calcification (AAC). We enrolled, in a cross-sectional study, 429 postmenopausal women [mean age, weight, and BMI of 59.5 ± 8.3 (50–83) years, 75.8 ± 13.3 (35–165) kg, and 29.9 ± 5.2 (14.6–50.8) kg/m2, respectively]. Lateral vertebral fracture assessment (VFA) images and scans of the lumbar spine and proximal femur were obtained using a Lunar Prodigy densitometer. Vertebral fractures (VFs) were defined using the Genant semiquantitative (SQ) approach. We used the Kauppila score to assess AAC extension. Clinical risk factors of osteoporosis were collected, and 25-hydroxy vitamin D was measured using electrochemiluminescence (Roche). Prevalence of osteoporosis and hypovitaminosis D (<20 ng/ml) was 21.0% and 78.1%, respectively. VFs grade 2/3 were identified in 76 patients (17.7%). Two thirds of the evaluable participants did not have any detectable AAC. The prevalence of significant atherosclerotic burden, defined as a radiographic 24-point AAC score of 5 or higher, was 7.9%. The group of women with extended AAC were older and had a statistically significant higher menopause duration and more prevalent grade 2/3 VFs. Compared to women with normal values of vitamin D, women with vitamin D insufficiency (<20 ng/ml) and deficiency (<10 ng/ml) had a lower BMD and more prevalent VFs. No difference was noted with regard to AAC among the three groups. Multiple stepwise conditional logistic regression analysis showed that the presence of AAC was associated significantly with age and the presence of VFs. Extended aortic calcifications are independently associated with prevalent VFA-identified VFs but not with serum vitamin D levels in postmenopausal women. VFA imaging using DXA may detect at the same time prevalent VFs and AAC, an important cardiovascular disease risk factor.


Abdominal aortic calcification Vertebral fracture assessment (VFA) Dual-energy X-ray absorptiometry (DXA) Osteoporosis Women 



The study was funded by grants from the University Mohammed V of Rabat and AMIRHAL (Association Marocaine d’Information et de Recherche sur l’Handicap et l’Appareil Locomoteur).

Compliance with ethical standards

Conflict of interest



  1. 1.
    Baldini V, Mastropasqua M, Francucci CM, D’Erasmo E (2005) Cardiovascular disease and osteoporosis. J Endocrinol Invest 28:69–72PubMedPubMedCentralGoogle Scholar
  2. 2.
    McFarlane SI, Muniyappa R, Shin JJ, Bahtiyar G, Sowers JR (2004) Osteoporosis and cardiovascular disease: brittle bones and boned arteries, is there a link? Endocrine 23:1–10CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Wilson PW, Kauppila LI, O’Donnell CJ, Kiel DP, Hannan M, Polak JM, Cupples LA (2001) Abdominal aortic calcific deposits are an important predictor of vascular morbidity and mortality. Circulation 103:1529–1534CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Golestani R, Tio R, Zeebregts CJ, Zeilstra A, Dierckx RA, Boersma HH, Hillege HL, Slart RH (2010) Abdominal aortic calcification detected by dual X-ray absorptiometry: a strong predictor for cardiovascular events. Ann Med 42:539–545CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Szulc P (2016) Abdominal aortic calcification: a reappraisal of epidemiological and pathophysiological data. Bone (NY) 84:25–37CrossRefGoogle Scholar
  6. 6.
    Ogawa T, Ishida H, Akamatsu M, Matsuda N, Fujiu A, Ito K, Ando Y, Nitta K (2010) Relation of oral 1alpha-hydroxy vitamin D3 to the progression of aortic arch calcification in hemodialysis patients. Heart Vessels 25:1–6CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Zagura M, Serg M, Kampus P, Zilmer M, Eha J, Unt E, Lieberg J, Cockcroft JR, Kals J (2011) Aortic stiffness and vitamin D are independent markers of aortic calcification in patients with peripheral arterial disease and in healthy subjects. Eur J Vasc Endovasc Surg 42:689–695CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Zittermann A, Schleithoff SS, Koerfer R (2007) Vitamin D and vascular calcification. Curr Opin Lipidol 18:41–46CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Schmidt N, Brandsch C, Kuhne H, Thiele A, Hirche F, Stangl GI (2012) Vitamin D receptor deficiency and low vitamin D diet stimulate aortic calcification and osteogenic key factor expression in mice. PLoS One 7:e35316CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Naves-Diaz M, Cabezas-Rodriguez I, Barrio-Vazquez S, Fernandez E, Diaz-Lopez JB, Cannata-Andia JB (2012) Low calcidiol levels and risk of progression of aortic calcification. Osteoporos Int 23:1177–1182CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Kim KJ, Kim KM, Park KH, Choi HS, Rhee Y, Lee YH, Cha BS, Kim MJ, Oh SM, Brown JK, Lim SK (2012) Aortic calcification and bone metabolism: the relationship between aortic calcification, BMD, vertebral fracture, 25-hydroxyvitamin D, and osteocalcin. Calcif Tissue Int 91:370–378CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Nargesi AA, Heidari B, Esteghamati S, Hafezi-Nejad N, Sheikhbahaei S, Pajouhi A, Nakhjavani M, Esteghamati A (2016) Contribution of vitamin D deficiency to the risk of coronary heart disease in subjects with essential hypertension. Atherosclerosis 244:165–171CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Aggarwal R, Akhthar T, Jain SK (2016) Coronary artery disease and its association with Vitamin D deficiency. J Mid-life Health 7:56–60CrossRefGoogle Scholar
  14. 14.
    Welles CC, Whooley MA, Karumanchi SA, Hod T, Thadhani R, Berg AH, Ix JH, Mukamal KJ (2014) Vitamin D deficiency and cardiovascular events in patients with coronary heart disease: data from the Heart and Soul Study. Am J Epidemiol 179:1279–1287CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Kunadian V, Ford GA, Bawamia B, Qiu W, Manson JE (2014) Vitamin D deficiency and coronary artery disease: a review of the evidence. Am Heart J 167:283–291CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Siasos G, Tousoulis D, Oikonomou E, Maniatis K, Kioufis S, Kokkou E, Vavuranakis M, Zaromitidou M, Kassi E, Miliou A, Stefanadis C (2014) Vitamin D3, D2 and arterial wall properties in coronary artery disease. Curr Pharm Des 20:5914–5918CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Zittermann A (2014) Vitamin D and cardiovascular disease. Anticancer Res 34:4641–4648PubMedPubMedCentralGoogle Scholar
  18. 18.
    El Maghraoui A, Roux C (2008) DXA scanning in clinical practice. Q J M 101:605–617CrossRefGoogle Scholar
  19. 19.
    Schousboe JT, Ensrud KE, Nyman JA, Kane RL, Melton LJ 3rd (2006) Cost-effectiveness of vertebral fracture assessment to detect prevalent vertebral deformity and select postmenopausal women with a femoral neck T-score >−2.5 for alendronate therapy: a modeling study. J Clin Densitom 9:133–143CrossRefPubMedCentralGoogle Scholar
  20. 20.
    Schousboe JT, Vokes T, Broy SB, Ferrar L, McKiernan F, Roux C, Binkley N (2008) Vertebral fracture assessment: the 2007 ISCD official positions. J Clin Densitom 11:92–108CrossRefPubMedCentralGoogle Scholar
  21. 21.
    El Maghraoui A, Rezqi A, Mounach A, Achemlal L, Bezza A, Ghozlani I (2012) Relationship between vertebral fracture prevalence and abdominal aortic calcification in men. Rheumatology (Oxf) 51:1714–1720CrossRefGoogle Scholar
  22. 22.
    Iwamoto J, Matsumoto H, Takeda T, Sato Y, Uzawa M (2010) A radiographic study on the associations of age and prevalence of vertebral fractures with abdominal aortic calcification in Japanese postmenopausal women and men. J Osteoporos 2010:748380CrossRefPubMedCentralGoogle Scholar
  23. 23.
    Schousboe JT, Lewis JR, Kiel DP (2017) Abdominal aortic calcification on dual-energy X-ray absorptiometry: Methods of assessment and clinical significance. Bone (NY)Google Scholar
  24. 24.
    Cecelja M, Frost ML, Spector TD, Chowienczyk P (2013) Abdominal aortic calcification detection using dual-energy X-ray absorptiometry: validation study in healthy women compared to computed tomography. Calcif Tissue Int 92:495–500CrossRefPubMedCentralGoogle Scholar
  25. 25.
    El Maghraoui A, Rezqi A, Mounach A, Achemlal L, Bezza A, Dehhaoui M, Ghozlani I (2013) Vertebral fractures and abdominal aortic calcification in postmenopausal women. A cohort study. Bone (NY) 56:213–219CrossRefGoogle Scholar
  26. 26.
    El Maghraoui A, Sadni S, El Maataoui A, El Maataoui A, Majjad A, Rezqi A, Ouzzif Z, Mounach A (2015) Influence of obesity on vertebral fracture prevalence and vitamin D status in postmenopausal women. Nutr Metab 12:44CrossRefGoogle Scholar
  27. 27.
    El Maghraoui A, Achemlal L, Bezza A (2006) Monitoring of dual-energy X-ray absorptiometry measurement in clinical practice. J Clin Densitom 9:281–286CrossRefPubMedCentralGoogle Scholar
  28. 28.
    El Maghraoui A, Do Santos Zounon AA, Jroundi I, Nouijai A, Ghazi M, Achemlal L, Bezza A, Tazi MA, Abouqual R (2005) Reproducibility of bone mineral density measurements using dual X-ray absorptiometry in daily clinical practice. Osteoporos Int 16:1742–1748CrossRefPubMedCentralGoogle Scholar
  29. 29.
    El Maghraoui A, Guerboub AA, Achemlal L, Mounach A, Nouijai A, Ghazi M, Bezza A, Tazi MA (2006) Bone mineral density of the spine and femur in healthy Moroccan women. J Clin Densitom 9:454–460CrossRefPubMedCentralGoogle Scholar
  30. 30.
    Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148CrossRefPubMedCentralGoogle Scholar
  31. 31.
    Kerkeni S, Kolta S, Fechtenbaum J, Roux C (2009) Spinal deformity index (SDI) is a good predictor of incident vertebral fractures. Osteoporos Int 20:1547–1552CrossRefPubMedCentralGoogle Scholar
  32. 32.
    Kauppila LI, Polak JF, Cupples LA, Hannan MT, Kiel DP, Wilson PW (1997) New indices to classify location, severity and progression of calcific lesions in the abdominal aorta: a 25-year follow-up study. Atherosclerosis 132:245–250CrossRefPubMedCentralGoogle Scholar
  33. 33.
    van der Meer IM, Bots ML, Hofman A, del Sol AI, van der Kuip DA, Witteman JC (2004) Predictive value of noninvasive measures of atherosclerosis for incident myocardial infarction: the Rotterdam Study. Circulation 109:1089–1094CrossRefPubMedCentralGoogle Scholar
  34. 34.
    Naves M, Rodriguez-Garcia M, Diaz-Lopez JB, Gomez-Alonso C, Cannata-Andia JB (2008) Progression of vascular calcifications is associated with greater bone loss and increased bone fractures. Osteoporos Int 19:1161–1166CrossRefPubMedCentralGoogle Scholar
  35. 35.
    Zhou R, Zhou H, Cui M, Chen L, Xu J (2014) The association between aortic calcification and fracture risk in postmenopausal women in China: the prospective Chongqing osteoporosis study. PLoS One 9:e93882CrossRefPubMedCentralGoogle Scholar
  36. 36.
    Szulc P, Blackwell T, Schousboe JT, Schousboe JT, Bauer DC, Cawthon P, Lane NE, Cummings SR, Orwoll ES, Black DM, Ensrud KE (2014) High hip fracture risk in men with severe aortic calcification: MrOS study. J Bone Miner Res 29:968–975CrossRefPubMedCentralGoogle Scholar
  37. 37.
    Szulc P, Samelson EJ, Sornay-Rendu E, Chapurlat R, Kiel DP (2013) Severity of aortic calcification is positively associated with vertebral fracture in older men–a densitometry study in the STRAMBO cohort. Osteoporos Int 24:1177–1184CrossRefGoogle Scholar
  38. 38.
    Rodondi N, Taylor BC, Bauer DC, Lui LY, Vogt MT, Fink HA, Browner WS, Cummings SR, Ensrud KE (2007) Association between aortic calcification and total and cardiovascular mortality in older women. J Intern Med 261:238–244CrossRefGoogle Scholar
  39. 39.
    Pradelli D, Faden G, Mureddu G et al (2013) Impact of aortic or mitral valve sclerosis and calcification on cardiovascular events and mortality: a meta-analysis. Int J Cardiol 170:e51–e55CrossRefGoogle Scholar
  40. 40.
    Nitta K, Ogawa T (2010) Aortic arch calcification and mortality in chronic hemodialysis patients. Rev Recent Clin Trials 5:133–137CrossRefPubMedCentralGoogle Scholar
  41. 41.
    Lampropoulos CE, Kalamara P, Konsta M, Papaioannou I, Papadima E, Antoniou Z, Andrianopoulou A, Vlachoyiannopoulos PG (2016) Osteoporosis and vascular calcification in postmenopausal women: a cross-sectional study. Climacteric 19:303–307CrossRefPubMedCentralGoogle Scholar
  42. 42.
    El Maghraoui A, Ouzzif Z, Mounach A et al (2012) Hypovitaminosis D and prevalent asymptomatic vertebral fractures in Moroccan postmenopausal women. BMC Womens Health 12:11CrossRefPubMedCentralGoogle Scholar
  43. 43.
    El Maataoui A, Biaz A, El Machtani S et al (2016) Vitamin D status in healthy Moroccan men and women aged 50 years and older: a cross-sectional study. Arch Osteoporos 11:24CrossRefPubMedCentralGoogle Scholar
  44. 44.
    Allali F, El Aichaoui S, Khazani H et al (2009) High prevalence of hypovitaminosis D in Morocco: relationship to lifestyle, physical performance, bone markers, and bone mineral density. Semin Arthritis Rheum 38:444–451CrossRefPubMedCentralGoogle Scholar
  45. 45.
    Melamed ML, Michos ED, Post W, Astor B (2008) 25-Hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 168:1629–1637CrossRefPubMedCentralGoogle Scholar
  46. 46.
    Zittermann A, Iodice S, Pilz S, Grant WB, Bagnardi V, Gandini S (2012) Vitamin D deficiency and mortality risk in the general population: a meta-analysis of prospective cohort studies. Am J Clin Nutr 95:91–100CrossRefGoogle Scholar
  47. 47.
    Wang L, Song Y, Manson JE, Pilz S, März W, Michaëlsson K, Lundqvist A, Jassal SK, Barrett-Connor E, Zhang C, Eaton CB (2012) Circulating 25-hydroxy-vitamin D and risk of cardiovascular disease: a meta-analysis of prospective studies. Circ Cardiovasc Qual Outcomes 5:819–829CrossRefPubMedCentralGoogle Scholar
  48. 48.
    Jaaskelainen T, Knekt P, Marniemi J, Sares-Jäske L, Männistö S, Heliövaara M, Järvinen R (2013) Vitamin D status is associated with sociodemographic factors, lifestyle and metabolic health. Eur J Nutr 52:513–525CrossRefPubMedCentralGoogle Scholar

Copyright information

© The Japanese Society for Bone and Mineral Research and Springer Japan 2017

Authors and Affiliations

  • A. El Maghraoui
    • 1
    Email author
  • T. Hamza
    • 1
  • S. Sadni
    • 1
  • A. El Maataoui
    • 2
  • A. Majjad
    • 1
  • A. Rezqi
    • 1
  • Z. Ouzzif
    • 2
  • A. Mounach
    • 1
  1. 1.Rheumatology Department, Military Hospital Mohammed VMohammed V Souissi UniversityRabatMorocco
  2. 2.Biochemistry Department, Military Hospital Mohammed VMohammed V Souissi UniversityRabatMorocco

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