Associations of cardiovascular-kidney-metabolic syndrome stage with trabecular bone score and bone mineral density

Abstract

Aim: The cardiovascular-kidney-metabolic (CKM) syndrome highlights the interplay among cardiovascular, renal, and metabolic disorders. However, its relationship with the trabecular bone score (TBS) and bone mineral density (BMD) remains unclear. We aimed to evaluate the association between the CKM syndrome stage and bone health-related indicators. Methods: Data from the 2005-2008 National Health and Nutrition Examination Survey were analyzed for 4,364 adults aged 30-79 years (median age 51 years; 51.9% male, 48.1% female). Bone health was assessed using TBS, femoral neck (FN) BMD, and lumbar spine (LS) BMD. Multivariate and segmented regression models were used to examine associations between CKM stages and TBS, FN BMD, and LS BMD. Results: Multivariate linear regression revealed a significant inverse correlation between CKM syndrome stage and TBS, which was predominantly observed across the early stages (0-2), while positive correlations were observed with FN BMD and LS BMD. No significant associations were found between CKM syndrome stage and osteoporosis or prior fractures. Conclusion: This study revealed a previously unrecognized dissociation in CKM syndrome, in which advanced stages were associated with a lower overall TBS despite higher FN BMD and LS BMD. This discordant pattern parallels the well-established diabetic bone paradox, underscoring the insufficiency of BMD alone for fracture risk assessment in patients with CKM syndrome. A comprehensive evaluation incorporating the TBS is essential to accurately assess bone fragility. Concurrent TBS assessment during routine BMD testing is recommended for patients with early-stage CKM to enable early detection of microarchitectural deficits.