Background/Purpose: Hip and knee osteoarthritis (OA) was associated with higher cardiovascular morbidity and mortality. Data on the cardiovascular status in men with spine OA are scarce. We assessed the association of spine OA with all cause mortality and with abdominal aortic calcification (AAC) severity and its progression rate in older men.

Methods: Men aged >50 (n=766) had lateral spine radiographs and blood collection and were followed up prospectively. Spine OA was assessed by Lane’s score (Lane et al., J Rheumatol, 1993). We calculated the total osteophyte score by adding up osteophyte scores for 6 intervertebral levels. We calculated total disc narrowing score (DSN) and total overall grade score similarly. AAC was assessed by Kauppila’s semiquantitative score (Atherosclerosis, 1997). We assessed the association of spine OA with all cause mortality (10 years), AAC severity and AAC progression (7.5 years).

Results:

Moderate and severe osteophytes were found in 85% of men, 72% of men had DSN. During the follow-up, 176 men died. After adjustment for confounders (age, BMI, AAC, smoking, physical activity, leg disability, diabetes, pulmonary diseases, Parkinson disease, 17b-estradiol, 25OHD, GFR, fat mass, vitamin D supplementation, vitamin K antagonists), the total overall grade spine OA score predicted all cause mortality (hazard ratio [HR]= 1.20 per SD increase, 95% confidence interval [95%CI]: 1.01-1.43, p<0.05). After adjustment for confounders, men who had both severe AAC (AAC>2) and severe OA (total overall grade score >8, highest tertile) had higher mortality than the reference group (AAC score ≤2 and total overall grade score ≤8): 51.8 vs 10.3 /1000 person-years; HR= 2.30, 95%CI: 1.34–3.96, p<0.005).

After adjustment for confounders, the odds of severe AAC (AAC>5) increased with total DSN score (HR= 1.44 per SD, 95%CI: 1.11-1.87, p<0.05). The highest tertile of total DSN score was associated with higher odds of severe AAC (adjusted HR= 2.42 versus two lower tertiles combined, i.e. >3 vs 0-3, 95%CI: 1.24-4.73, p<0.005). Finally, probability of long-term AAC stability decreased with increasing total osteophyte score (adjusted HR= 0.66 per SD, 95%CI: 0.49-0.88, p<0.05). The highest tertile of total osteophyte score (>10) was associated with lower probability of AAC stability (adjusted HR= 0.35 versus the lowest tertile, i.e. 0-6, 95%CI: 0.18-0.71, p<0.01).

OA therapy (non-steroidal anti-inflammatory drugs, analgesics) had no impact on the results of all the above analyses.

 Conclusion: Older men with severe spine OA have greater AAC severity, faster AAC progression and higher all-cause mortality. Higher mortality may be partly mediated by lower physical activity and metabolic abnormalities.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/spine-osteoarthritis-is-associated-with-all-cause-mortality-in-older-men/