Abdominal aortic calcification and skeletal outcomes in hospitalized patients with surgically treated fragility fractures: a retrospective cohort study.

UNLABELLED: Abdominal aortic calcification was associated with lower femoral neck BMD in unadjusted analyses, but its independent skeletal stratification value was limited in hospitalized patients with surgically treated fragility fractures. AAC was not independently associated with fracture severity or refracture risk in this cohort. PURPOSE: Abdominal aortic calcification (AAC) has been linked to lower bone mineral density (BMD) and fracture risk in community-based populations, but its relevance for skeletal stratification after surgically treated fragility fracture is unclear. We examined associations between AAC burden and BMD, FRAX-estimated fracture probabilities, fracture severity, and refracture risk. METHODS: We retrospectively studied 230 hospitalized adults with surgically treated fragility hip or vertebral fractures. AAC was quantified on lateral spine radiographs using the 24-point Kauppila score. Associations with BMD, FRAX probabilities, and fracture severity were assessed using correlation and multivariable regression. Refracture was analyzed using Kaplan-Meier and Cox models from a common baseline defined as the latest of the index operation, DXA, and AAC assessment dates. RESULTS: Higher AAC burden was associated with lower femoral neck BMD in unadjusted analyses (Spearman ρ = - 0.230, p < 0.001), but this association was attenuated after adjustment. AAC showed weak positive correlations with FRAX-estimated probabilities but was not independently associated with vertebral or hip fracture severity. In common-baseline refracture analysis, 24/224 patients had a first refracture. Refracture-free survival did not differ by AAC group (log-rank p = 0.982), and high AAC was not associated with refracture risk (HR 0.90, 95% CI 0.38-2.15; p = 0.809). CONCLUSION: In this fracture-selected inpatient cohort, AAC showed limited independent value for skeletal stratification beyond shared demographic and body-composition factors. AAC was not independently associated with fracture severity, and refracture analyses should be interpreted as exploratory because of the limited number of events.