This study aimed to evaluate the association of bone metabolism markers with
coronary atherosclerosis and
coronary artery disease (CAD) in postmenopausal women. Based on the findings of coronary angiography, 111 women with CAD and 116 women without CAD were recruited. Serum
calcium, phosphate,
parathyroid hormone (PTH),
25-hydroxyvitamin D (25OHD),
osteocalcin, N-terminal propeptide of
type I procollagen (P1NP) and C-terminal cross-linked telopeptide of
type I collagen (CTX) were measured. The Gensini score was used to assess the severity of
coronary atherosclerosis. Compared with women with serum
calcium ≤2.29 mmol/L, women with serum
calcium >2.29 mmol/L had a 2.63-fold increased risk of CAD after adjusting for multiple cardiovascular risks, PTH and 25OHD [odds ratio (OR) = 2.91, 95% confidence interval (CI) 1.35-6.28]. In the fully adjusted model plus PTH and 25OHD, the risk of CAD increased 1.87-fold with every 1-SD increment of serum
calcium (OR = 1.87, 95% CI 1.21-2.88). To further analyze the potential strong confounding effect of
albumin, the absolute levels of
calcium were replaced by their
albumin-corrected values in the regression model. Compared with women with
albumin-corrected
calcium ≤2.27 mmol/L, women with
albumin-corrected
calcium >2.27 mmol/L had a 2.36-fold increased risk of CAD in the fully adjusted model plus PTH and 25OHD (OR = 2.36, 95% CI 1.13-4.92). The risk of
coronary atherosclerosis as defined by Gensini score >0 increased 1.73-fold with every 1-SD increment of serum
calcium in the fully adjusted model plus PTH and 25OHD (OR = 1.73, 95% CI 1.09-2.73). However,
albumin-corrected
calcium was not associated with
coronary atherosclerosis either as a categorical variable or as a continuous variable in all models. No significant association of PTH, 25OHD,
osteocalcin, CTX and P1NP with CAD or
coronary atherosclerosis was found in this study. Higher serum
calcium levels were independently associated with CAD in postmenopausal women.