{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T23:23:44Z","timestamp":1768519424065,"version":"3.49.0"},"reference-count":18,"publisher":"BMJ","issue":"4","funder":[{"name":"National Health and Medical Research Council of Australia (NHMRC) Career Development Fellowship for J.R.L & D.S"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,1,31]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Abdominal aortic calcification (AAC) is associated with low bone mass and increased fracture risk. Two previous meta-analyses have investigated the association between AAC and fracture. However, these meta-analyses only identified articles until December 2016, undertook limited searches and did not explore potential sources of between-study heterogeneity. We aim to undertake a sensitive and comprehensive assessment of the relationship between AAC, bone mineral density (BMD) as well as prevalent and incident fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We will search MEDLINE, EMBASE, Web of Science core collection and Google Scholar (top 200 articles sorted by relevance) from their inception to 1 June 2018. Reference lists of included studies and previous systematic reviews will be hand searched for additional eligible studies. Retrospective and prospective cohort studies (cross-sectional, case\u2013control and longitudinal) reporting the association between AAC, BMD and fracture at any site will be included. At least two investigators will independently: (A) evaluate study eligibility and extract data, with a third investigator to adjudicate when discrepancies occur, (B) assess study quality by the Newcastle-Ottawa Scale for each cohort\/study. The meta-analysis will be reported in adherence to the Meta-analysis of Observational Studies in Epidemiology criteria. AAC will be grouped as either: (1) AAC present or absent, (2) AAC categorised as \u2018low\u2019 (referent\u2014lowest reported group) versus \u2018high\u2019 (all other groups) or (3) dose\u2013response when AAC was assessed in \u22653 groups. Where primary event data were reported in individual studies, pooled risk differences and risk ratios with 95%\u2009CI will be calculated, from which, a summary estimate will be determined using DerSimonian-Laird random effects models. For the AAC and BMD pooled analyses, estimates will be expressed as standardised mean difference with 95%\u2009CI. We will examine the likelihood of publication bias and where possible, investigate potential reasons for between-study heterogeneity using subgroup analyses and meta-regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study will be submitted to a peer- reviewed journal and disseminated via research presentations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42018088019.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-026232","type":"journal-article","created":{"date-parts":[[2019,4,3]],"date-time":"2019-04-03T07:35:59Z","timestamp":1554276959000},"page":"e026232","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Abdominal aortic calcification, bone mineral density and fractures: a systematic review and meta-analysis protocol"],"prefix":"10.1136","volume":"9","author":[{"given":"Alexander J","family":"Rodr\u00edguez","sequence":"first","affiliation":[{"name":"Bone and Muscle Health Research Group, School of Clinical Sciences at Monash Health, Monash Medical Centre, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Leow","sequence":"additional","affiliation":[{"name":"The University of Sydney, Centre for Kidney Research, School of Public Health, Sydney Medical School, Children\u2019s Hospital at Westmead, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pawel","family":"Szulc","sequence":"additional","affiliation":[{"name":"INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, Lyon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Scott","sequence":"additional","affiliation":[{"name":"Bone and Muscle Health Research Group, School of Clinical Sciences at Monash Health, Monash Medical Centre, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Ebeling","sequence":"additional","affiliation":[{"name":"Bone and Muscle Health Research Group, School of Clinical Sciences at Monash Health, Monash Medical Centre, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5166-0605","authenticated-orcid":false,"given":"Marc","family":"Sim","sequence":"additional","affiliation":[{"name":"School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia"},{"name":"Medical School, Royal Perth Hospital Unit, The University of Western Australia, Western Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Germaine","family":"Wong","sequence":"additional","affiliation":[{"name":"The University of Sydney, Centre for Kidney Research, School of Public Health, Sydney Medical School, Children\u2019s Hospital at Westmead, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wai H","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Sir Charles Gairdner Hospital, Western Australia, Australia"},{"name":"Medical School, The University of Western Australia, Western Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John T","family":"Schousboe","sequence":"additional","affiliation":[{"name":"Division of Health Policy and Management, Park Nicollet Osteoporosis Center and Health Partners Institute, University of Minnesota, Minneapolis, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas 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