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Osteoporosis and cardiovascular disease (CVD) share common risk factors; both often remain undiagnosed until a major life-threatening event occurs. We investigated the associations between cardiac workload, peripheral vascular calcification (PVC), and bone parameters in Gambian adults. The Gambian Bone and Muscle Aging Study (GamBAS) recruited 249 women and 239 men aged 40 to 75+\u2009years. Body composition and areal bone mineral density (aBMD) were measured using dual-energy X-ray absorptiometry; peripheral quantitative computed tomography (pQCT) scans were performed at the radius and tibia. Supine blood pressure and heart rate were measured and used to calculate rate pressure product and pulse pressure. Presence of PVC was determined from tibia pQCT scans. Sex interactions were tested (denoted as p-int); adjustments were made for residuals of appendicular lean mass (ALM) and fat mass (FM). There were negative associations between rate pressure product and aBMD in women only, all p-int\u2009&amp;lt;\u2009.05; after adjustment for ALM residuals, for every 10% increase in rate pressure product, aBMD was lower at the whole body (\u22120.6% [\u22121.2, \u22120.1]), femoral neck (\u22120.9% [\u22121.8, \u22120.05]), L1 to L4 (\u22120.6% [\u22121.7, 0.5]), and radius (\u22121.9% [\u22122.8, \u22120.9]); there were similar associations when adjusted for FM residuals. Similar negative associations were found between pulse pressure and aBMD in women only. PVC were found in 26.6% men and 22.5% women; women but not men with calcification had poorer cardiac health and negative associations with aBMD (all sites p-int\u2009&amp;lt;\u2009.001). There were consistent associations with cardiac parameters and pQCT outcomes at the radius and tibia in women only. Multiple markers of cardiac health are associated with poorer bone health in Gambian women. In the context of epidemiological transition and changing NCD burden, there is a need to identify preventative strategies to slow\/prevent the rising burden in CVD and osteoporosis in Sub-Saharan Africa. \u00a9 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).<\/jats:p>","DOI":"10.1002\/jbmr.4196","type":"journal-article","created":{"date-parts":[[2020,10,29]],"date-time":"2020-10-29T12:49:23Z","timestamp":1603975763000},"page":"227-235","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Sex-Specific Associations Between Cardiac Workload, Peripheral Vascular Calcification, and Bone Mineral Density: The Gambian Bone and Muscle Aging Study"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6428-6165","authenticated-orcid":false,"given":"Ayse","family":"Zengin","sequence":"first","affiliation":[{"name":"MRC Nutrition and Bone Health Group Cambridge UK"},{"name":"Department of Medicine School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University Clayton Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Landing M","family":"Jarjou","sequence":"additional","affiliation":[{"name":"MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine Banjul Gambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramatoulie E","family":"Janha","sequence":"additional","affiliation":[{"name":"MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine Banjul Gambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann","family":"Prentice","sequence":"additional","affiliation":[{"name":"MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine Banjul Gambia"},{"name":"MRC Nutrition and Bone Health Group Cambridge UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3510-0709","authenticated-orcid":false,"given":"Cyrus","family":"Cooper","sequence":"additional","affiliation":[{"name":"National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit University of Oxford Oxford UK"},{"name":"MRC Lifecourse Epidemiology Unit University of Southampton Southampton UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2921-3742","authenticated-orcid":false,"given":"Peter R","family":"Ebeling","sequence":"additional","affiliation":[{"name":"Department of Medicine School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University Clayton Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7034-6750","authenticated-orcid":false,"given":"Kate A","family":"Ward","sequence":"additional","affiliation":[{"name":"MRC Lifecourse Epidemiology Unit University of Southampton Southampton UK"},{"name":"MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine Banjul Gambia"},{"name":"MRC Nutrition and Bone Health Group Cambridge 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