Low bone density and abnormal bone turnover in patients with atherosclerosis of peripheral vessels.

Abstract

Patients with vascular calcifications often have low bone mineral density (BMD), but it is still uncertain if osteoporosis and peripheral vascular disease (VD) are interrelated and linked by a common pathomechanism. Moreover, data on bone turnover in patients with advanced atherosclerosis are lacking. We measured BMD by dual-energy X-ray absorptiometry (DXA) and quantitative bone ultrasound (QUS), as well as the serum levels of osteocalcin (OC), bone-specific alkaline phosphatase (BAP), osteoprotegerin (OPG) and its ligand RANKL, and the urinary concentration of the C-terminal telopeptides of type I collagen (CrossLaps), in 36 patient (20 male and 16 female) with serious atherosclerotic involvement of the carotid and/or femoral artery to investigate the underlying mechanism of vascular and osseous disorders. Thirty age-matched and gender matched healthy individuals served as controls. After adjustment for age, BMD was significantly reduced at the lumbar spine in 23/36 (63%) patients (mean T score -1.71+/-1.42) and at the proximal femur in 34/36 (93%) patients (neck mean T score -2.5+/-0.88). Ten patients (27%) had abnormal QUS parameters. Gender and diabetes had no effect on the relationship between vascular calcification and bone density at any site measured. VD subjects had OC and BAP serum levels lower than controls (13.3+/-3.1 vs 27.7+/-3.3 ng/ml, P<0.01, and 8.4+/-2.3 vs 12.5+/-1.4 microg/l, P<0.01, respectively). Urinary CrossLaps excretion was not significantly different in patients with VD and in controls (257.9+/-138.9 vs 272.2+/-79.4 micro g/mmol Cr, respectively). Serum OPG and RANKL levels were similar in patients and in controls (3.5+/-1.07 vs 3.4+/-1.05 pmol/l, and 0.37+/-0.07 vs 0.36+/-0.06 pmol/l, respectively). We proved high occurrence of osteoporosis in VD, with evidence of age and gender independence. Negative bone remodelling balance would be a consequence of reduced bone formation, with no apparent increased activation of the OPG-RANKL system.

Increased Bone Turnover in Patients with Hypercholesterolemia

“…Because higher T-C, higher LDL-C, and lower HDL-C may be associated with gonadal hypofunction or atherosclerosis, the latter may be the underlying factor in the correlation of T-C, LDL-C or HDL-C with bone turnover markers detected in our study. This is supported by the findings by Pennisi et al [2], of a negative bone remodeling balance in patients with atherosclerosis. Although indirectly, our results thus support the possibility of a relationship between osteoporosis and atherosclerosis.…”

“…PREVIOUS clinical studies have linked osteoporosis with atherosclerosis [1,2] and/or cardiovascular diseases [3,4], suggesting the possibility of a common underlying factor or mechanism among these diseases [5][6][7][8][9][10]. Hypercholesterolemia has been proposed as one of the most likely candidates [5][6][7][8][9][10].…”

Clinical Significance of 1-year Treatment with Raloxifene on Bone and Lipid Metabolism in Japanese Postmenopausal Women with Osteoporosis

“…On the other hand, the potential relationship between hyperlipidemia and osteoporosis has often been referred to by some investigators [28,29]. Epidemiological or observational clinical studies have repeatedly reported that osteoporosis coexists with arteriosclerotic vascular diseases [30], and lipids have been suggested as a common underlying pathogenetic factor affecting both of these two diseases [28,29]. Indeed, whether lipids affect bone metabolism or not remains unclear thus far.…”

Prevention of osteoporosis by angiotensin-converting enzyme inhibitor in spontaneous hypertensive rats

“…Compared with healthy controls, reduced bone mineral density (BMD) has been found in patients with hypertension or ischemic heart disease. [1][2][3][4] Clinical studies have shown significant abnormalities in calcium metabolism in hypertension, [5][6][7] and a decreased circulating level of calcium results in an increased parathyroid hormone, which is implicated in the occurrence and/or development of hypertension. 8 Animal and epidemiological evidence suggests that high blood pressure is associated with abnormalities of calcium metabolism, leading to an increase in calcium loss, to a secondary activation of the parathyroid gland and to an increased movement of calcium from bone, thereby increasing the risk of osteoporosis.…”