🔗 Tulane University's Groundbreaking Insights on Bone and Heart Connections

Researchers at Tulane University School of Medicine have uncovered a compelling connection between cardiovascular health and bone fragility in women, particularly after menopause. Their recent study, published in The Lancet Regional Health - Americas, analyzed data from over 21,300 postmenopausal women enrolled in the Women's Health Initiative (WHI), one of the largest and longest-running investigations into women's health led by multiple U.S. universities including the University of Pittsburgh and UCLA. Lead investigator Rafeka Hossain, MSPH, and colleagues applied the American Heart Association's PREVENT calculator—a tool designed to predict 10-year cardiovascular disease (CVD) risk based on factors like blood pressure, cholesterol, diabetes, smoking, and kidney function—to assess fracture risks.

The findings were striking: women in the highest CVD risk category faced a 93% increased hazard ratio (HR 1.93) for hip fractures compared to those at lowest risk, with intermediate-risk women showing a 33% elevation (HR 1.33). Notably, high-risk women experienced fractures nearly five years earlier on average—median 15 years versus 20 years. This association held even after adjusting for demographics, lifestyle, BMI, falls history, and hormone therapy, and was strongest in women under 65, suggesting early postmenopausal vigilance is key.

These results build on decades of academic inquiry, positioning Tulane's work as a pivotal advancement in understanding how heart health metrics can flag bone vulnerabilities before fractures occur.

Decoding the PREVENT Score and Its Role in Bone Health Prediction

The PREVENT (Predicting Risk via an Enhanced Vector of Easy-to-Treat Indicators) score, introduced by the American Heart Association in 2023, represents a modern evolution in CVD risk assessment. Unlike older models like the Framingham Risk Score, PREVENT incorporates social determinants, kidney function (via eGFR), and statin use, providing a more holistic 10-year outlook for events like heart attacks, strokes, and heart failure. Tulane researchers retrospectively applied it to WHI baseline data from 1993-1998, categorizing women as low (<5%), borderline (5-7.4%), intermediate (7.5-19.9%), or high (≥20%) risk.

While PREVENT excels at forecasting heart events, the study reveals its untapped potential for bone health screening. For major osteoporotic fractures (MOF)—hip, spine, forearm, shoulder—high-risk women had a 22% higher risk (HR 1.22). Even accounting for competing mortality risks using Fine-Gray models, the hip fracture link persisted (sub-distribution HR 1.36). This suggests subclinical vascular changes captured by PREVENT directly impair bone integrity, offering clinicians at universities like Tulane a dual-purpose tool.

Shared Biological Pathways: Why Bones and Heart Decline Together

The bone-heart nexus stems from intertwined physiological processes, extensively reviewed in academic literature from institutions like Harvard and the University of California. Estrogen deficiency post-menopause accelerates both: it ramps up osteoclast activity, eroding bone mineral density (BMD)—the measure of calcium and minerals per bone volume via dual-energy X-ray absorptiometry (DXA) scans—while promoting arterial stiffness and plaque buildup.

Chronic inflammation plays a starring role. Pro-inflammatory cytokines like interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) stimulate bone resorption and endothelial dysfunction, fostering atherosclerosis. Oxidative stress from reactive oxygen species damages osteoblasts (bone-building cells) and vascular linings alike. Vascular calcification diverts calcium from bones to arteries, a process amplified by hyperparathyroidism and phosphate dysregulation.

Reduced bone perfusion from clogged vessels starves osteocytes, while metabolic syndrome—common in postmenopausal women—exacerbates insulin resistance, linking diabetes to both low BMD and CVD. Studies from the Study of Osteoporotic Fractures (SOF), a multicenter U.S. effort, confirm faster bone loss predicts coronary mortality, with each standard deviation increase in hip BMD loss raising total mortality 1.3-fold.

Prevalence and Burden: Alarming U.S. Statistics for Women

In the U.S., osteoporosis affects about 10 million adults, with women comprising 80% due to menopause-accelerated bone loss (1-2% annually at the spine, 0.5-1% at the hip). One in three women over 50 will suffer an osteoporotic fracture, costing $19 billion yearly in medical care. CVD remains the top killer, claiming 1 in 3 women; postmenopausal prevalence hits 44% by age 60.

WHI data underscores disparities: 33.8% Black women in the cohort faced nuanced risks, with weaker hip associations possibly due to inherently higher BMD. Obesity modifies effects—high CVD risk with BMI ≥30 doubled hip fracture hazard (HR 2.19). Lifetime projections: nearly 6 in 10 women may develop CVD by 2050, per AHA 2026 stats.

Implications for Postmenopausal Women and Clinical Practice

For the estimated 40 million U.S. postmenopausal women, these findings urge integrated care. Hossain notes, “Taking care of your heart and bones should go hand in hand.” High-risk individuals might prioritize DXA scans; effective treatments like bisphosphonates reduce fractures 40-70%, while denosumab targets RANKL to curb resorption.

University clinics, from Tulane to UC San Diego collaborators, advocate screening intermediate/high-risk per PREVENT before 65, when associations peak. Addressing modifiable factors slashes dual risks: quitting smoking halves CVD odds, exercise boosts BMD 1-3% yearly.

Evidence from Broader Academic Research Landscape

Tulane's work echoes multi-institutional efforts. A 2025 NHANES analysis (Scientific Reports) using Life’s Essential 8 (LE8) CV health score found high CVH cuts osteoporotic fracture odds 34% (OR 0.66). SOF and Framingham cohorts link low BMD to 1.2-fold CVD mortality rise.

International perspectives, like Central South University's NHANES review, confirm inverse CVH-fracture trends across sexes. Meta-analyses affirm per-SD BMD drop raises all-cause mortality 17%, CVD 13%—stronger in women.

Practical Prevention: Lifestyle and Medical Strategies

• Physical Activity: Weight-bearing (walking, yoga) 30 min/day preserves BMD, lowers CVD 30%.
• Diet: 1200mg calcium, 800-2000 IU vitamin D daily; DASH pattern reduces hypertension, supports bones.
• Weight Management: BMI 18.5-24.9 optimal; excess fat fuels inflammation.
• Screenings: Annual BP/cholesterol, DXA every 2 years post-65 or high-risk.
• Medications: Statins for CVD may stabilize BMD; monitor bisphosphonates for atypical femur risks.

Hossain emphasizes shared protectors: “Regular activity, calcium/vitamin D-rich diet, no smoking, diabetes/BP control benefit both.” Try the PREVENT calculator yourself.

Challenges, Limitations, and the Path Forward

Despite robust design, Tulane's study notes limitations: self-reported fractures (though validated), baseline-only exposures, survivor bias. Future WHI extensions could track dynamic BMD/CVD changes. Emerging research probes genetics (e.g., LRP5 variants), AI-enhanced PREVENT for fracture prediction.

University-led trials, like those at Brigham and Women's, test combo therapies. Policy-wise, integrating CV-bone metrics in guidelines could save billions, enhancing women's longevity.

Empowering Women Through Knowledge and Action

This Tulane-led discovery reframes menopause not as isolated bone loss, but a CVD signal too. Consult providers for personalized PREVENT/DXA; join university wellness programs. By prioritizing dual health, women can fracture-proof their futures while safeguarding hearts—academic research lighting the way.

Photo by Europeana on Unsplash