Association between cardiovascular diseases and osteoporosis—reappraisal

Abstract

Many studies published over the past 20 years show a significant positive association between cardiovascular diseases (CVD) and osteoporosis. This association is important because it concerns two major public health problems. The investigation of shared biomarkers (clinical, radiological, biochemical) may improve identification of subjects at high risk of both diseases. The investigation of shared pathophysiological mechanisms may help to understand the pathophysiology of these diseases and to establish new treatments that could be efficient in both diseases. Below, I have tried to analyze various groups of clinical studies to better understand the association between osteoporosis and CVD as well as discrepancies between the studies. My review is focused on the epidemiological studies of the general population, and I have not analyzed the association between bone and CVD in chronic renal failure. Association between Cardiovascular Diseases and Bone Mineral DensitySeveral studies showed that CVD and arterial calcification are associated with decreased bone mineral density (BMD), although findings vary according to skeletal site and gender. Severe abdominal aortic calcification (AAC) was associated with lower BMD at the spine and hip in older women, 1 at the hip and whole body (but not spine) in older women (but not men), 2 at the lumbar spine (but not femoral neck) in a cohort of men and women, 3 at the femoral neck in women 4 and at whole body and distal forearm (but not at the spine or hip) in older men. 5 Severe AAC was associated with lower trabecular volumetric BMD at the spine in postmenopausal women, 6 in peri-and postmenopausal black and white women, 7 and in men and women aged у 45 years. 8 In a group of siblings concordant for type 2 diabetes, severity of the coronary and aortic calcification was correlated negatively with spine volumetric BMD. 9 In other studies, the association between AAC severity and BMD was weak or non-significant. 10 -13 Limited data also suggest a weak but significant association between severe peripheral arterial disease (PAD) and lower BMD at the hip. 14 -16 Elevated diastolic (but not systolic) blood pressure was associated with lower BMD at the total body, trochanter and Ward ' s triangle in a small group of 47 men aged 24 to 77 years. 17 REVIEW Association between cardiovascular diseases and osteoporosis -reappraisal Pawel SzulcINSERM UMR 1033, Universit é de Lyon, H ô pital Edouard Herriot , Lyon , France .Positive association between cardiovascular diseases and osteoporosis is important because it concerns two major public health problems. Men and women with cardiovascular diseases (including severe abdominal aortic calcification (AAC) and peripheral arterial disease) tend to have lower areal and volumetric bone mineral density (BMD) as well as faster bone loss, although findings vary according to skeletal site. On one hand, severe forms of cardiovascular diseases (heart failure, myocardial infarction, hypertension, severe AAC) are associated with higher risk of osteop...

The associations of subclinical atherosclerotic cardiovascular disease with hip fracture risk and bone mineral density in elderly adults

“…Epidemiological studies suggest an association between clinical cardiovascular disease (CVD) and osteoporotic fracture risk (1–6). Given that clinical CVD and fractures are end-stage disorders preceded by subclinical disorders – atherosclerosis that is neither symptomatic nor clinically recognized, and osteoporosis, respectively – these subclinical disorders may also be related to one another.…”

“…Most of the studies that have examined the association of subclinical atherosclerosis with fracture risk have focused on vascular calcification as the marker of vascular disease (1–4). Calcification of the fibrous capsule of an atherosclerotic plaque or of the medial layer of the arterial wall is a process different from thickening of the intima and media, plaque formation, and vessel stenosis (11, 12).…”

Cardiovascular Calcification and Bone: A Comparison of The Effects of Dietary and Serum Calcium, Phosphorous, Magnesium and Vitamin D

“…Although these conditions commonly co-occur in older adults, growing evidence suggests an association between vascular calcification and skeletal fragility that is independent of age and other shared risk factors. Older adults with the greatest bone loss have the greatest progression of vascular calcification 1,2 and the incidence of cardiovascular (CV) events is greater in women with lower bone mass 3 and in men with higher levels of bone resorption 4,5 . The association between both pathologies also depends on the mechanisms involved in the regulation of bone and CV metabolism 5 .…”

“…Older adults with the greatest bone loss have the greatest progression of vascular calcification 1,2 and the incidence of cardiovascular (CV) events is greater in women with lower bone mass 3 and in men with higher levels of bone resorption 4,5 . The association between both pathologies also depends on the mechanisms involved in the regulation of bone and CV metabolism 5 . We have previously shown that the nutrients and micronutrients that benefit the CV system generally also benefit bone [6][7][8] .…”

Investigation of calcium metabolism in patients with coronary heart disease complicated by chronic heart failure, stage ii-a

“…Thirdly, coexistence of osteoporosis and CVD may be due to common genetic factors. Genome-wide association studies have identified several genes and single nucleotide polymorphisms associated with BMD, and CVD risk factors or metabolic traits, including high density lipoprotein, low density lipoprotein, triglycerides, type 1 diabetes, type 2 diabetes, systolic blood pressure, diastolic blood pressure and waist hip ratio [13,15,16,17]. Furthermore osteoprotegerin and receptor activator of nuclear factor kappa B ligand regulate osteoclast activation and function but are also involved in the vascular calcification process and atherosclerosis.…”