Matthew J. Budoff, MD: Examining the Interplay of Coronary Calcium and Osteoporosis

In this expert interview at the 22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC), Matthew Budoff, MD, a professor of medicine at the David Geffen School of Medicine at UCLA and an investigator at The Lundquist Institute, discussed the intersection of coronary artery calcium (CAC) and osteoporosis, emphasizing how these conditions share overlapping pathophysiology as diseases of aging.

Budoff highlighted findings from studies, including the Multi-Ethnic Study of Atherosclerosis, showing that elevated CAC scores not only predicted cardiovascular events but also correlated with lower bone density and increased fracture risk. Importantly, this relationship is bidirectional—osteoporosis independently increases the risk of atherosclerosis, myocardial infarction, stroke, and cardiovascular mortality. Leveraging advanced imaging techniques, clinicians have developed algorithms to measure bone density from coronary calcium scans or routine CT imaging, allowing simultaneous diagnosis of atherosclerosis and osteoporosis. Budoff indicated this approach could bridge the diagnostic gap, as only 8% of Medicare beneficiaries currently receive bone density testing despite the high osteoporosis prevalence.

The conversation also addressed high-risk populations, including older adults, smokers, Caucasians, and those undergoing significant weight loss due to obesity medications, which exacerbate osteoporosis risk. Budoff urged clinicians to prioritize bone density screening for postmenopausal women and men over 65, using existing CT imaging when DEXA scans are unavailable. By recognizing the dual risk of cardiovascular disease and osteoporosis, Budoff suggested healthcare providers can implement earlier interventions to improve patient outcomes.

Relevant disclosures for Budoff include AstraZeneca, Amarin, Merck, Novo Nordisk, Regeneron, and others.

Reference

Budoff MJ. CAC in ASCVD Relation to Bone Density & Osteoporosis. Presented at the 22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC). Los Angeles, California. December 12-14, 2024.