The Silent Threats of Aging: Fear of Fragile Bones, Stiff Arteries, or Time’s Inevitable Betrayal? An Age-Matched Study

Introduction: This study assessed the predictive power of femoral neck (FN) bone mineral density (BMD) and pulse wave velocity (PWV) for fracture and cardiovascular-related mortality over a three-year follow-up in a representative cohort. Methods: A total of 142 participants (54 males, 38%), aged 56 ± 7.2 years, were enrolled in this prospective observational study. FN BMD was measured using dual-energy X-ray absorptiometry (DXA), and carotid-to-femoral PWV was determined via Doppler ultrasound. Results: Mean PWV was significantly higher in non-survivors compared to survivors (10.9 ± 3.2 m/s vs. 8.6 ± 2.1 m/s, p = 0.0041). FN BMD was lower in non-survivors (0.658 ± 0.131 g/cm²) than in survivors (0.852 ± 0.150 g/cm², p = 0.002). Logistic regression identified PWV as a strong determinant of mortality [coefficient: 0.1593; odds ratio (OR): 1.17; 95% confidence interval (CI): 1.04–1.32; p = 0.01], while FN BMD also showed significance (coefficient: –6.6336; OR: 0.0013; 95% CI: 0.000–0.156; p = 0.0064). However, in age-matched analysis, only PWV remained significant (OR: 2.77; 95% CI: 1.70–4.51; p < 0.0001]. Receiver operating characteristic (ROC) analysis demonstrated superior predictive accuracy for PWV [area under the curve (AUC): 0.958; cutoff: 11.3 m/s; sensitivity: 94.6%; specificity: 88.1%] compared with FN BMD (AUC: 0.560). Conclusion: PWV showed outstanding accuracy for predicting all-cause mortality, outperforming FN BMD and remaining independent of age. These findings establish PWV as a robust prognostic marker for mortality risk, highlighting its potential role in improving clinical risk stratification for vascular aging and cardiovascular outcomes.