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

Maja Avramovska 1 2, Petar Jovan Avramovski 2 3 * , Liljana Todorovska 4, Biljana Taleva 5, Kosta Sotiroski 6, Dejan Zdraveski 7
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1 Department of Obstetrics and Gynecology, Clinical Hospital D-r Trifun Panovski, North Macedonia
2 University St. Clement of Ohrid, Bitola, North Macedonia
3 Clinical Hospital D-r Trifun Panovski, Bitola, North Macedonia.
4 Clinicl hospital D-r Trifun Panovski, Bitola, North Macedonia, Department of Nuclear Medicine
5 Department of Children Surgery, “Mother Teresa Clinical Center – Skopje”, Skopje, North Macedonia.
6 University St. Clement of Ohrid, Bitola, Faculty of Economics – Prilep, Depatment of Statistics, North Macedonia.
7 University St. Clement of Ohrid, Bitola, Faculty of economics, Prilep, North Macedonia
* Corresponding Author
J CLIN MED KAZ, Volume 22, Issue 6, pp. 10-18. https://doi.org/10.23950/jcmk/17357
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Author Contributions: M. A., the lead physician, oversaw participant selection, study implementation, and medical history analysis. She identified pathophysiological links between bone health and arterial stiffness, supported findings with references, ensured data analysis aligned with results, and critically reviewed the manuscript for scientific rigor. She also conducted a comprehensive literature review and played a key role in the study’s conception, data analysis, and discussion. P. A. contributed to data organization, statistical validation, and ensuring methodological accuracy. He assisted in refining the discussion by integrating relevant findings and enhancing the manuscript's clarity and coherence. L. T., contributed by analyzing diagnostic imaging, interpreting data, and ensuring accurate result interpretation. She also managed data organization in Excel, enhancing the clarity and reliability of the findings. B. T. contributed by sourcing relevant literature, refining the discussion, enhancing tables, and improving language, spelling, and grammar. K. S. applied statistical methods, interpreted results, and provided key insights, ensuring a strong data-driven foundation for the study. D. Z., an informatics and cloud expert, managed data collection, storage, and processing. He supervised statistical methods and contributed to result interpretation in the discussion. All authors collaborated in writing, reviewing, and reaching a unanimous consensus on the final manuscript.

Data availability statement: The data supporting the findings of this clinical study are included within the manuscript. Due to the sensitive nature of patient’s information, additional data will not be made publicly available to maintain patient confidentiality. Specific data requests will be evaluated on a case-by-case basis, with consideration of ethical and privacy requirements.

Patient Informed Consent Statement: Written informed consent was obtained from all participants involved in the study, ensuring they understood the study’s purpose, procedures, and their right to confidentiality.

Artificial Intelligence (AI) Disclosure Statement: AI-Unassisted Work.

ABSTRACT

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.
Keywords: Femoral Neck, Pulse Wave Velocity, Osteoporosis, Bone health, Arterial Stiffness.

CITATION

Avramovska M, Avramovski PJ, Todorovska L, Taleva B, Sotiroski K, Zdraveski D. The Silent Threats of Aging: Fear of Fragile Bones, Stiff Arteries, or Time’s Inevitable Betrayal? An Age-Matched Study. J CLIN MED KAZ. 2025;22(6):10-8. https://doi.org/10.23950/jcmk/17357

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