Abstract: Objective To investigate the risk factors associated with cardiac syndrome X (CSX) in the elderly women, with a particular focus on the impact of bone mineral density (BMD) and bone metabolism markers. Methods A total of 256 elderly women admitted to the Fourth Affiliated Hospital of Nanjing Medical University from 2021 to 2024 were divided into the CSX group (n=126) and the control group (n=130). The general clinical data, bone mineral density (BMD) and bone turnover markers were compared between the two groups, and the influencing factors of CSX in the elderly women were analyzed by logistic regression analysis. Results The CSX group showed higher proportion of alcohol abuse, smoking, hypertension and osteoporosis, along with elevated levels of low-density lipoprotein cholesterol (LDL-C) and electrocardiograph ST-segment depression, compared with the control group (P<0.05). Conversely, the levels of high-density lipoprotein cholesterol (HDL-C) and estradiol were significantly lower in the CSX group (P<0.05). The BMD of lumbar spine and femoral neck, and the level of 25-hydroxyvitamin D were significantly lower (P<0.05), and the levels of bone alkaline phosphatase (BALP), osteocalcin (BGP), and procollagen Ⅰ N-terminal propeptide (P1NP) were significantly higher in the CSX group than those in the control group (P<0.05). Logistic regression analysis revealed that decreased femoral neck BMD, reduced estradiol level, elevated LDL-C, and increased levels of P1NP, BALP, and BGP were independent risk factors for CSX in the elderly women. Conclusions Reduced BMD, hypoestrogenism, dyslipidemia, and increased bone turnover jointly drive the incidence of CSX in the elderly women. Integrated management should target both bone metabolism and cardiovascular risk.

Key words: elderly women, cardiac syndrome X, bone mineral density, bone metabolism