Bone metabolism and vascular calcification

Abstract

Osteoporosis and atherosclerosis are chronic degenerative diseases which have been considered to be independent and whose common characteristic is increasing incidence with age. At present, growing evidence indicates the existence of a correlation between cardiovascular disease and osteoporosis, irrespective of age. The morbidity and mortality of osteoporosis is mainly related to the occurrence of fractures. Atherosclerosis shows a high rate of morbidity and especially mortality because of its clinical repercussions such as angina pectoris, acute myocardial infarction, stroke, and peripheral vascular insufficiency. Atherosclerotic disease is characterized by the accumulation of lipid material in the arterial wall resulting from autoimmune and inflammatory mechanisms. More than 90% of these fatty plaques undergo calcification. The correlation between osteoporosis and atherosclerosis is being established by studies of the underlying physiopathological mechanisms, which seem to coincide in many biochemical pathways, and of the risk factors for vascular disease, which have also been associated with a higher incidence of low-bone mineral density. In addition, there is evidence indicating an action of antiresorptive drugs on the reduction of cardiovascular risks and the effect of statins, antihypertensives and insulin on bone mass increase. The mechanism of arterial calcification resembles the process of osteogenesis, involving various cells, proteins and cytokines that lead to tissue mineralization. The authors review the factors responsible for atherosclerotic disease that correlate with low-bone mineral density.

Correlations between 10-year risk of death from cardiovascular diseases

“…The literature reports broadly inform about higher incidence rates of osteoporosis in patients affected by arterial hypertension and type 1 diabetes mellitus [2,3,19] and about increased risk of bone fractures in patients with DM t. 2 [20] (RAC-OST-POL study showed also that diabetes t. 1 increased the risk of fall [21]) -in our study, probably, it would be easier to illustrate the difference in the case of a higher number of patients.…”

“…Metabolic disorders find solid confirmation in literature reports, which bring up examples of cases with the elderly, in whom metabolic disturbances overtly correlated with atheromatosis and osteoporosis progression. That particular concomitance of medical conditions can be explained by the fact that dyslipidaemia (especially the rise of LDL, with a simultaneous fall of HDL) plays a major role in the process of atheromatous plaque formation (while simultaneously supressing osteoblast activity in the osseous tissue), enhances calcification processes in vascular walls, and is associated with bone mass losses in postmenopausal women [2]. However, one article reports the opposite, with the suggestion that cholesterol levels in young and middle-aged patients do not appear to have long-term clinical implications for osteoporosis [22].…”

“…osteoprotegerin, parathyroid hormone, phosphates, vitamins D and K, seem to be involved in both osteoporosis and CVD [23]. Only scarce reports indicate that osteoprotegerin most effectively illustrates the bone-arterial relationships [5,18] and, while controlling osteoclast activity and functions, it also influences the process of calcification and atherosclerosis (90% of atherosclerotic plaques undergo calcification), being also associated with an increased risk of diabetes mellitus and death from cardiovascular disease [2]. It is also reported that BMPs (bone morphogenetic proteins), ALP (alkaline phosphatase), and OPN (osteopontin) -factors involved in osteogenesis -are correlated with vascular calcification [19].…”

“…Osteoporosis is a chronic disease, concomitant with other medical conditions, including coronary arterial disease (CAD), arterial hypertension (HA), and other cardiovascular disorders [1][2][3][4][5][6][7][8].…”

“…The incidence of both osteoporosis and CVD grows with age [2,6]. Attention should be drawn to the observed coexistence of the same risk factors for osteoporosis and cardiovascular diseases, except the age, which include sedentary lifestyle, impaired lipid metabolism, tobacco smoking, and excessive alcohol consumption [5], similarly to the presence of the same proinflammatory markers (including CRP, IL6, TNF-α, and TNF-β) [2].…”