Background: Osteoporosis is consistently reported to increase mortality risk in older adults. Whether trabecular bone score (TBS), an indirect index of trabecular microarchitecture, increases mortality risk has not been widely studied. Methods: Participants aged 60 years and older in the National Health and Nutritional Examination Survey 2005 to 2008 with complete data on TBS lumbar vertebrae were linked to the public-use mortality files through December 31st, 2019. The X-tile software (version 3.6.1; Yale University) was used to obtain the overall and sex-specific optimal TBS cut-off values associated with all-cause mortality (log-rank test P<0.0001). Then, TBS was grouped into low (≤1.24), medium (1.25-1.39), and high (≥1.40) categories. Results: A total of 2,641 participants with a mean age of 69.8 (standard error 0.2) years comprised the study sample. Of those, 1,109 older adults died after a median follow-up of 140 months. Overall, survival probability progressively decreased across TBS categories, which was accentuated in subjects with low TBS. Cox regression analysis demonstrated that participants with low TBS had 47% (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.10-1.96) greater all-cause mortality risk than their counterparts with high TBS, even after accounting for potential confounders including bone mineral density. Notably, older adults with low TBS had 2-fold higher risk of cancer-related mortality than those with high TBS (HR, 2.07; 95% CI, 1.17-3.67). Conclusions Low TBS was significantly associated with greater all-cause and cancer-related mortality in older adults.

Background: Abdominal aortic calcification (AAC) on lateral lumbar radiographs increases the risk of cardiovascular events and mortality. However, data on the association between AAC detected in dual energy X-ray absorptiometry (DXA) and the risk of mortality in the general population are scarce. Methods: The present study was based on data from participants aged ≥40 years in the National Health and Nutrition Examination Survey (NHANES) cycle of 2013 to 2014. Vertebral assessment of lateral spine DXA scans was used to provide AAC measurements at vertebrae L1–L4. The extent of AAC was defined according to the Kauppila AAC-24 scores (0–1, 2–5, ≥6), and the NHANES 2019 public-use linked mortality files were used to assess mortality status. Results: Of the 2,962 participants who were included in this study, with a mean age of 57.4 years and a median follow-up of 69.9 months, 252 (8.5%) died. Of the deaths, 84 (33.3%) occurred due to cardiovascular disease. The Cox proportional hazards models revealed that participants with AAC-24 scores ≥6 were 1.7 times more likely to die than those with AAC-24 scores 0–1 (Hazard ratio, 1.75; 95% confidence interval, 1.13–2.71). Moreover, older adults and women with AAC-24 scores ≥6 were 2.8 and 2.4 times more likely to die than their counterparts with AAC-24 scores 0–1, respectively. Conversely, a non-significant risk of cardiovascular mortality was found among participants with AAC-24 scores ≥6. Conclusions The extent of AAC detected on vertebral fracture assessment DXA was associated with an increased risk of all-cause mortality in adults, particularly older adults and women.