Opportunistic abdominal aortic calcification assessment on spine radiographs in women with longstanding rheumatoid arthritis: linking cardiovascular burden and femoral neck bone loss

Introduction/objectives Cardiovascular disease (CVD) and osteoporosis are major comorbidities in rheumatoid arthritis (RA). We assessed abdominal aortic calcification (AAC) opportunistically on spine radiographs and examined its associations with CVD, estimated cardiovascular risk, bone mineral density (BMD), and fragility fractures in women with longstanding RA. Method This cross-sectional study included 196 consecutive women with longstanding RA followed at a tertiary hospital. All underwent dual-energy X-ray absorptiometry and conventional spine radiography. AAC was graded using the Kauppila score (KS) and categorized as absent, mild-to-moderate (KS 1–6), or extended (KS > 6). Multivariable models evaluated factors associated with AAC and overt CVD. Results Participants had a mean age of 62.8 ± 9.6 years and median RA duration of 21 years. AAC was present in 48 women (24.5%), including extended AAC in 25 (12.7%). Overt CVD was documented in 32 participants (16.3%). Extended AAC was independently associated with hypertension (OR 8.57, 95% CI 1.10–67.02), longer RA duration (OR 1.05 per year, 95% CI 1.004–1.09), and lower femoral neck T-score (OR 0.57, 95% CI 0.35–0.95). AAC of any severity was associated with overt CVD (OR 2.89, 95% CI 1.26–6.63). Conclusions AAC detected on routine spine radiographs was common among women with longstanding RA and was associated with cardiovascular burden and lower femoral neck BMD. Opportunistic AAC assessment may complement cardiovascular and skeletal risk evaluation in RA. Larger cohorts are needed to confirm these exploratory associations, and prospective studies are needed to establish predictive value. Key Points • AAC can be assessed opportunistically on routine spine radiographs in women with longstanding RA. • AAC was associated with overt cardiovascular disease and estimated cardiovascular risk. • Extended AAC was linked to hypertension, RA duration, and lower femoral neck BMD. • Spine radiographs may support integrated vascular and skeletal risk assessment in RA.