Association between bone mineral density and stroke: a meta-analysis

Objective: The correlation between bone mineral density (BMD) and stroke remains inconsistent. This study aims to determine whether a reduction in BMD is associated with an increased risk of stroke. Methods: We systematically searched Medline, Embase, and the Cochrane Database of Systematic Reviews through January 2025 to identify cohort studies with follow-up that reported the influence of a reduction in BMD or low BMD status on the risk of any type of stroke. Pooled analyses were performed using random-effects models. Results: This study included 13 studies with 146,758 individuals. A 1 SD reduction in BMD was associated with an increased risk of stroke (eight studies; RR, 1.24; 95% CI, 1.09-1.40; p < 0.001; I-2 = 87%). Subgroup analysis showed that a per SD reduction in BMD was associated with incident stroke in female persons (eight studies; RR, 1.28; 95% CI, 1.09-1.51; p = 0.002; I-2 = 87%), but not in male persons (four studies; RR, 1.04; 95% CI, 0.99-1.10; p = 0.15; I-2 = 0%). People with osteoporosis or osteopenia had an increased risk of incident stroke (six studies; RR, 1.59; 95% CI, 1.22-2.08; p < 0.001; I-2 = 92%), as well as male persons (two studies; RR, 3.16; 95% CI, 1.96-5.12; p < 0.001; I-2 = 35%). Sensitivity analysis showed that the results were stable. Conclusion: Reduction in BMD is associated with a significantly increased risk of stroke. Female individuals have a higher risk than male persons.