Osteoporosis and Cardiovascular Disease: Brittle Bones and Boned Arteries, Is There a Link?

Abstract

Both osteoporosis and cardiovascular disease (CVD) are major public health problems leading to increased morbidity and mortality. Although traditionally viewed as separate disease entities that increase in prevalence with aging, accumulating evidence indicates that there are similar pathophysiological mechanisms underlying both diseases. In addition to menopause and advanced age, other risk factors for CVD such as dyslipidemia, oxidative stress, inflammation, hyperhomocystinemia, hypertension, and diabetes have also been associated with increased risk of low bone mineral density (LBMD). Elevated LDL and low HDL cholesterol are associated with LBMD, altered lipid metabolism is associated with both bone remodeling and the atherosclerotic process, which might explain, in part, the co-existence of osteoporosis and atherosclerosis in patients with dyslipidemia. Similarly, inflammation plays a pivotal role in both atherosclerosis and osteoporosis. Elevated plasma homocysteine levels are associated with both CVD and osteoporosis. Nitric oxide (NO), in addition to its known atheroprotective effects, appears to also play a role in osteoblast function and bone turnover. Supporting this notion, in a small randomized controlled trial, nitroglycerine (an NO donor) was found to be as effective as estrogen in preventing bone loss in women with surgical menopause. Statins, agents that reduce atherogenesis, also stimulate bone formation. Furthermore, bis- phosphonates, used in the treatment of osteoporosis, have been shown to inhibit atherogenesis. Intravenous bisphosphonate therapy significantly decreases serum LDL and increases HDL in postmenopausal women The exciting possibilities of newer pharmacological agents that effectively treat both osteoporosis and CVD hold considerable promise. However, it is important to emphasize that the current evidence linking both of these diseases is far from conclusive. Therefore, additional research is necessary to further characterize the relationship between these two common illnesses.

Height loss starting in middle age predicts increased mortality in the elderly

“…(44) Some evidence indicated similar pathophysiological mechanisms underlying both osteoporosis and cardiovascular disease. (45,46) Risk factors such as age, diabetes, hypertension, inflammation, dislipidemia, homocystienemia, and estrogen deficiency are prevalent in both disorders. (44,47) Osteoporotic fracture and mortality Bliuc et al (48) reported that excess mortality was highest immediately after almost all fragility fracture events and then declined.…”

Fasudil hydrochloride induces osteoblastic differentiation of stromal cell lines, C3H10T1/2 and ST2, via bone morphogenetic protein-2 expression

“…Many clinical studies have shown that osteoporosis is associated with the cardiovascular disease and influences mortality [26][27][28][29][30]. Although both diseases are traditionally viewed as separate disease entities that increase in prevalence with aging, accumulating evidence indicates that there are similar pathophysiological mechanisms underlying them.…”

Hip fracture and risk of acute myocardial infarction: A nationwide study

“…(6) A previous clinical study has shown that patients with self-reported myocardial infarction had significantly higher odds of having low hip bone mineral density (BMD). (7) In addition, the presence of coronary calcifications has been associated with a nonsignificant 8% lower lumbar spine BMD, (8) suggesting that there is an association between subclinical atherosclerosis and lower bone density in the elderly.…”