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Tjandra PM, Ripplinger CM, Christiansen BA. The heart-bone connection: relationships between myocardial infarction and osteoporotic fracture. Am J Physiol Heart Circ Physiol 2024; 326:H845-H856. [PMID: 38305753 PMCID: PMC11062618 DOI: 10.1152/ajpheart.00576.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
Myocardial infarction (MI) and osteoporotic fracture (Fx) are two of the leading causes of mortality and morbidity worldwide. Although these traumatic injuries are treated as if they are independent, there is epidemiological evidence linking the incidence of Fx and MI, thus raising the question of whether each of these events can actively influence the risk of the other. Atherosclerotic cardiovascular disease and osteoporosis, the chronic conditions leading to MI and Fx, are known to have shared pathoetiology. Furthermore, sustained systemic inflammation after traumas such as MI and Fx has been shown to exacerbate both underlying chronic conditions. However, the effects of MI and Fx outside their own system have not been well studied. The sympathetic nervous system (SNS) and the complement system initiate a systemic response after MI that could lead to subsequent changes in bone remodeling through osteoclasts. Similarly, SNS and complement system activation following fracture could lead to heart tissue damage and exacerbate atherosclerosis. To determine whether damaging bone-heart cross talk may be important comorbidity following Fx or MI, this review details the current understanding of bone loss after MI, cardiovascular damage after Fx, and possible shared underlying mechanisms of these processes.
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Affiliation(s)
- Priscilla M Tjandra
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, United States
- Biomedical Engineering Graduate Group, University of California Davis, Davis, California, United States
| | - Crystal M Ripplinger
- Biomedical Engineering Graduate Group, University of California Davis, Davis, California, United States
- Department of Pharmacology, University of California Davis Health, Davis, California, United States
| | - Blaine A Christiansen
- Biomedical Engineering Graduate Group, University of California Davis, Davis, California, United States
- Department of Orthopaedic Surgery, University of California Davis Health, Sacramento, California, United States
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Tan A, Shu J, Huang H, Shao H, Yang J. The correlation between the serum LDL-C/Apo B ratio and lumbar bone mineral density in young adults. BMC Musculoskelet Disord 2023; 24:213. [PMID: 36949432 PMCID: PMC10031959 DOI: 10.1186/s12891-023-06325-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/15/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Numerous studies have confirmed that atherosclerosis is related to osteoporosis (OP), and patients with atherosclerosis are more prone to OP. The ratio of low-density lipoprotein cholesterol (LDL-C) to apolipoprotein B (Apo B) is the valid indicator of atherosclerosis. Nevertheless, conclusions regarding relation between LDL-C/Apo B ratio and bone mineral density (BMD) are still lacking. As a result, this study concentrated on investigating the relationship between LDL-C/Apo B ratio and lumbar BMD in the young adult population according to the National Health and Nutrition Examination Survey (NHANES). METHODS Information of 2027 young adults (age 20-40 years) from NHANES database was obtained for this cross-sectional study. The correlation between serum LDL-C/Apo B ratio and lumbar BMD was explored through weighted multiple stratified linear regression, while the smooth curve fitting model was utilized for analyzing nonlinear relation. In the nonlinear relation, the inflection point was calculated by saturation threshold analysis. The weighted two-piecewise linear regression model was constructed. RESULTS After covariates were adjusted, the relation between serum LDL-C/Apo B ratio and lumbar BMD varied by sex (males: β = -0.0126, 95% CI -0.0892, 0.0640; females: β = 0.0322, 95% CI -0.0367, 0.1011). By performing age-stratified subgroup analysis, the association also varied by age and sex. Males aged 20-30 years presented a negative trend (β = -0.0570, 95% CI -0.1656, 0.0517), and males with the age of 31-40 years showed a positive trend (β = 0.0810, 95% CI -0.0312, 0.1931). Women showed a positive trend by age (females of 20-30 years: β = 0.0051, 95% CI -0.0935, 0.1036; females of 31-40 years: β = 0.0265, 95% CI -0.0767, 0.1296). In race-stratified subgroup analysis, the relations varied by sex and race. To be specific, non-Hispanic black males showed a negative trend (β = -0.0754, 95% CI -0.2695, 0.1188), and males of other races exhibited a positive trend. The trend was positive for women of all races. CONCLUSION Differences were detected in the association between serum LDL-C/Apo B ratio and lumbar BMD among cases aged 20-40 years across sex, age, and race/ethnicity. In addition, the inflection points in U-shaped relationships were also calculated.
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Affiliation(s)
- Anjun Tan
- Department of Geriatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650034, People's Republic of China
| | - Juntao Shu
- Department of Neonatology, The Children's Hospital of Kunming City, The Affiliated Children's Hospital of Kunming Medical University, Kunming, Yunnan, 650103, People's Republic of China
| | - Hong Huang
- Department of Geriatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650034, People's Republic of China
| | - Heng Shao
- Department of Geriatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650034, People's Republic of China
| | - Jingjing Yang
- Department of Geriatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650034, People's Republic of China.
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Zhang X, Xu Y, Li F, Chen M. Associations between bone mineral density and subclinical peripheral arterial disease in elderly men with type 2 diabetes mellitus. Osteoporos Int 2022; 33:1715-1724. [PMID: 35451624 DOI: 10.1007/s00198-022-06404-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 04/12/2022] [Indexed: 12/24/2022]
Abstract
UNLABELLED The association between peripheral arterial disease (PAD) and osteoporosis in elderly men with type 2 diabetes mellitus (T2DM) remains unclear. We demonstrated the association between subclinical PAD and decreased total hip bone mineral density (BMD) in men aged ≥ 55 years with T2DM, providing clinical clues for the early detection of decreased bone density in total hip. PURPOSE To investigate the association between subclinical peripheral arterial disease (PAD) and bone mineral density (BMD) at total hip, femoral neck, and lumbar spine (L1-4) in elderly men with type 2 diabetes mellitus (T2DM). METHODS We identified 2,466 patients with confirmed diabetes in this retrospective cross-sectional study. A total of 272 men aged ≥ 55 years with T2DM (50 with subclinical PAD and 222 without PAD) were analyzed. Partial correlation analysis was conducted to explore the associations between ankle-brachial index (ABI) and BMD. Multivariate logistic regression analysis was performed to analyze the contributor for low bone density (T-score < - 1.0). RESULTS Patients with T2DM and subclinical PAD (ABI ≤ 0.9) had significantly lower total hip BMD and T-score (BMD, 0.87 ± 0.14 vs. 0.92 ± 0.15 g/cm2, P = 0.014; T-score, -1.30 [-1.70 to -0.45] vs. -0.80 [-1.40 to 0.00], P = 0.009) than those in the control group. The partial correlation analyses indicated that ABI significantly correlated with the total hip T-score (adjusted r = 0.166, P = 0.009). The logistic regression analysis indicated that subclinical PAD was an independent risk factor for the risk of decreased bone density in total hip (adjusted odds ratio [95% CI]: 8.933 [1.075-74.222], P = 0.043). CONCLUSION: Subclinical PAD (ABI ≤ 0.9) could be used as a risk factor for decreased total hip BMD in men aged ≥ 55 years with T2DM, which provides clinical clues for the early detection of low bone density in total hip in such populations.
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Affiliation(s)
- X Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Y Xu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - F Li
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - M Chen
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Lu CF, Liu WS, Huang HY, Ge XQ, Hua LY, Wang XQ, Su JB. The Positive Relationship Between the Low-Density Lipoprotein Cholesterol/Apoprotein B Ratio and Bone Turnover Markers in Patients With Type 2 Diabetes. Front Endocrinol (Lausanne) 2022; 13:903336. [PMID: 35757416 PMCID: PMC9223462 DOI: 10.3389/fendo.2022.903336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dyslipidemia may contribute to low bone turnover in patients with type 2 diabetes (T2D) through mediating oxidative stress and atherosclerosis. The low-density lipoprotein cholesterol/apoprotein B (LDL-C/Apo B) ratio is a surrogate marker of small and density low-density lipoprotein cholesterol (sd-LDL-C), a most harmful group of LDL-Cs. The present study aimed to investigate the association between the LDL-C/Apo B ratio and bone turnover in patients with T2D. METHODS This study was a cross-sectional study enrolled patients with T2D from January 2021 to December 2021. Each participant was assessed for lipid profiles, bone turnover markers (BTMs), lumbar spine (L1-L4) and hip dual-energy X-ray absorptiometry (DXA) scans. Osteoporosis was diagnosed as a T-score lower than or equal to -2.5 at the spine or hip. RESULTS A total of 335 patients with T2D were enrolled in the study, and the LDL-C/Apo B ratio ranged from 0.78 to 4.00. Along with the LDL-C/Apo B ratio tertile ascending, osteocalcin (OC), C-terminal telopeptide (CTx) and N-terminal propeptide of type-I procollagen (PINP) levels gradually increased (all p < 0.05). There were no differences in lumbar spine and hip T-score, proportion of osteoporosis (all p > 0.05) among the three subgroups. The LDL-C/Apo B ratio was positively correlated with lnOC (r = 0.244, p < 0.001), lnCTx (r = 0.226, p < 0.01) and lnPINP (r = 0.211, p < 0.001). These significant positive correlations persisted even when divided into male and female subgroups. Furthermore, three multiple linear regression analyses were constructed to investigate the independent association of the LDL-C/Apo B ratio with the BTMs levels. After adjusting for other clinical parameters, the LDL-C/Apo B ratio was still significantly associated with OC level (β = 0.199, t = 3.348, p < 0.01), CTx level (β = 0.238, t = 4.084, p < 0.001) and PINP level (β = 0.162, t = 2.741, p < 0.01). CONCLUSION The LDL-C/Apo B ratio was significantly and positively associated with BTMs in patients with T2D. In clinical practice, more attention should be paid to the patients with T2D whose LDL-C/Apo B ratio is relatively low for the purpose of maintaining bone health.
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Affiliation(s)
- Chun-feng Lu
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
- *Correspondence: Chun-feng Lu, ; Xue-qin Wang, ; Jian-bin Su,
| | - Wang-shu Liu
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
| | - Hai-yan Huang
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
| | - Xiao-qin Ge
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
| | - Ling-yan Hua
- Department of Ophthalmology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
| | - Xue-qin Wang
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
- *Correspondence: Chun-feng Lu, ; Xue-qin Wang, ; Jian-bin Su,
| | - Jian-bin Su
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
- *Correspondence: Chun-feng Lu, ; Xue-qin Wang, ; Jian-bin Su,
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Osteoprotegerin expression and serum values in obese women with type 2 diabetes mellitus. Mol Biol Rep 2021; 48:7095-7104. [PMID: 34487291 PMCID: PMC8419664 DOI: 10.1007/s11033-021-06699-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/31/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Obesity and diabetes prevalence are increasing worldwide. We aimed to detect the possible association of osteoprotegerin (OPG) gene expression with visceral adiposity indices and cardiometabolic risk factors among obese women. METHODS AND RESULTS The study enrolled 150 controls and 150 obese cases subdivided into two subgroups non-diabetic (n = 70) and 80 patients with type 2 diabetes mellitus (T2DM). Circulating OPG gene expression levels were figured out by real time PCR (Polymerase Chain Reaction). Serum OPG levels were assessed by Enzyme Linked Immunosorbent Assay. Our results explored that OPG serum levels were lower in the obese women compared to control group (p < 0.001) and obese diabetics had higher serum levels of OPG in comparison to obese non-diabetic patients (p < 0.001). Expression levels of OPG were higher in obese women than controls (p < 0.001). Moreover, the blood expression levels of OPG gene were higher in diabetic obese patients than non-diabetics. We found positive correlations between parameters of metabolic syndrome and obesity indices. After adjustment of the traditional risk factors, stepwise linear regression analysis test revealed that OPG expression levels were independently correlated with glycated hemoglobin, high-density lipoprotein-cholesterol, and waist-to-hip ratio. CONCLUSIONS OPG mRNA levels were associated with surrogate markers of insulin resistance in Egyptian obese women.
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Gaudio A, Xourafa A, Rapisarda R, Castellino P. Therapeutic Options in the Management of Aromatase Inhibitor-Associated Bone Loss. Endocr Metab Immune Disord Drug Targets 2021; 22:259-273. [PMID: 34370654 DOI: 10.2174/1871530321666210809153152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Breast cancer is the most commonly occurring cancer in women worldwide. Early breast cancer is a kind of invasive neoplasm that has not proliferated beyond the breast or the axillary lymph nodes. Current therapeutic strategies for breast cancer mainly include local therapies such as surgery or radiotherapy and systemic therapies like chemotherapy, endocrine, and targeted therapy.Nowadays, the adjuvant treatment for hormone receptor-positive early breast cancer in postmenopausal women remains the main effective systemic therapy which can improve disease-free survival and overall survival; it involves several endocrine treatment regimens including selective estrogen receptor modulators (SERMs), aromatase inhibitors (AIs), or a combination of them. AIs have been shown to be more effective in preventing recurrence in postmenopausal women with early breast cancer when compared with tamoxifen, thus representing the standard of care for adjuvant endocrine therapy. Although AIs are usually well-tolerated, they can have some side effects. Apart from the appearance of arthralgias or myalgias and cardiovascular events, AI therapies, reducing already low endogenous postmenopausal estradiol levels, cause increased bone loss and increase fracture risk in postmenopausal women. OBJECTIVES To evaluate the therapeutic options in the management of aromatase inhibitor-associated bone loss (AIBL). METHODS We reviewed the current literature dealing with different therapeutic options in the treatment of AIBL. RESULTS Clinical practice guidelines recommend a careful evaluation of skeletal health in all women with breast cancer before AI therapy initiation. Adequate calcium and vitamin D intake have also been suggested. Pharmacological attempts to minimize AI-related bone loss have focused on the use of antiresorptive agents, such as bisphosphonates and denosumab, to protect bone integrity and reduce the risk of fractures. Furthermore, clinical trials have shown that by making the bone microenvironment less susceptible to breast cancer metastasis, these drugs are able to increase disease-free survival. CONCLUSIONS AI, thatare the pillar of the systemic treatment for patients with hormone receptor-positive breast cancer, are associated with different side effects, and in particular osteoporosis and fractures. Both bisphosphonates and denosumab are able to prevent this negative effect.
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Affiliation(s)
- Agostino Gaudio
- Department of Clinical and Experimental Medicine, University of Catania , Italy
| | | | | | - Pietro Castellino
- Department of Clinical and Experimental Medicine, University of Catania , Italy
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7
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Carmona-Fernandes D, Barreira SC, Leonardo N, Casimiro RI, Castro AM, Santos PO, Fernandes AN, Cortes-Figueiredo F, Gonçalves CA, Cruz R, Fernandes ML, Ivo M, Pedro LM, Canhão H, Fonseca JE, Santos MJ. Atherosclerosis and Bone Loss in Humans-Results From Deceased Donors and From Patients Submitted to Carotid Endarterectomy. Front Med (Lausanne) 2021; 8:672496. [PMID: 34095177 PMCID: PMC8172790 DOI: 10.3389/fmed.2021.672496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/19/2021] [Indexed: 12/25/2022] Open
Abstract
Background and Aims: Atherosclerosis and osteoporosis share common risk factors, as well as inflammatory mechanisms. Our aim was to understand how atherosclerotic lesions are related with disturbances in bone. Methods: Gene expression of pro-inflammatory and bone metabolism related proteins (IL-1β, IL-6, IL-17A, TNF, RANKL, OPG, COL1, CTSK, OCL, TRAP, CBFA1, DKK1, SOST, ADIPOQ, and ADIPOR1) were analyzed in arteries and bones from 45 deceased donors and adipose tissue was used as control. Additionally, in 139 patients with advanced atherosclerosis submitted to carotid endarterectomy we compared calcium content (Alizarin red) and plaque inflammatory scores (CD3+, CD68+, and adiponectin) of patients with normal bone mineral density (BMD) with those with low BMD and explored the associations between gene expression in atherosclerotic plaques and BMD. Serum levels of pro-inflammatory and bone related proteins were measured both in donors and patients. Associations were investigated by the Pearson or Spearman correlation tests, and multivariate regression analyzes were performed when justified. Results: Gene expression of bone remodeling and pro-inflammatory proteins correlated positively in bone and aorta, independently of age and sex of donors, but not in adipose tissue. The expression of bone formation genes was significantly higher in atheroma plaques from endarterectomized patients with normal vs. low BMD as well as inflammatory CD68+ scores, regardless of patients' age and sex, but not of body mass index. No relationship was observed between serum levels and gene expression levels of pro-inflammatory or bone remodeling proteins. Conclusions: Our results suggest that the relationship between bones and vessels in the context of atherosclerotic disease and osteoporosis may rely on the intrinsic connection between the tissues involved, independently of disease stage. Serum measurements of pro-inflammatory and bone-remodeling proteins do not accurately translate tissue pathologic processes.
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Affiliation(s)
- Diana Carmona-Fernandes
- Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Sofia C Barreira
- Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal.,Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - Natacha Leonardo
- Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Renata I Casimiro
- Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Alice M Castro
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal
| | | | - António N Fernandes
- Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Filipe Cortes-Figueiredo
- Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Carolina A Gonçalves
- Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Rafael Cruz
- Pathology Department, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal.,Faculdade de Medicina da Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Instituto de Histologia e Biologia do Desenvolvimento, Lisboa, Portugal
| | - Mariana L Fernandes
- Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Margarida Ivo
- Transplantation Department, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Luis M Pedro
- Vascular Surgery Department, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Helena Canhão
- EpiDoC Unit-CEDOC, Comprehensive Health Research Center-CHRC, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal.,Rheumatology Unit, Centro Hospitalar Universitario Lisboa Central, Lisboa, Portugal
| | - João Eurico Fonseca
- Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal.,Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - Maria José Santos
- Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal.,Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal
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Early vascular ageing biomarkers in osteoporotic outpatients: a pilot study. Sci Rep 2020; 10:19421. [PMID: 33173083 PMCID: PMC7656252 DOI: 10.1038/s41598-020-76427-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis and atherosclerosis are significant public health problems that often coexist, especially in the elderly. Although some studies have reported an age-dependent relationship, others have suggested a causal relationship between osteoporosis and atherosclerosis. The aim of our study was to evaluate the cardiovascular risk in a population of patients with osteoporosis by measuring carotid intima-media thickness (cIMT) and carotid-femoral pulse wave velocity (cf-PWV). A total of 58 patients with osteoporosis and an equal number of healthy control subjects were enrolled. All subjects underwent (1) a bone densitometry examination using dual X-ray absorptiometry, (2) a vascular evaluation for the measurements of cIMT and cf-PWV and (3) a blood sample for the evaluation of lipids and phosphocalcic metabolism. Patients with osteoporosis had a significant increase in cIMT and cf-PWV. There was also a significant inverse correlation between the femoral neck BMD and cf-PWV values. In conclusion, osteoporotic outpatients have earlier vascular ageing, with an increase of arterial stiffness. These data support a possible association between osteoporosis and atherosclerosis independent of age.
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Hu X, Ma S, Yang C, Wang W, Chen L. Relationship between senile osteoporosis and cardiovascular and cerebrovascular diseases. Exp Ther Med 2019; 17:4417-4420. [PMID: 31105781 PMCID: PMC6507516 DOI: 10.3892/etm.2019.7518] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/18/2019] [Indexed: 02/07/2023] Open
Abstract
The relationship between senile osteoporosis and cardiovascular hypertension, coronary heart disease and cerebral infarction was investigated. A retrospective study on 428 elderly patients hospitalized in Harrison International Peace Hospital from June 2014 to January 2017 was conducted. There were 207 cases of coronary heart disease, 102 cases of hypertension and 119 cases of cerebral infarction. According to bone density measurement results, the subjects were divided into the osteoporosis group and the non-osteoporosis group. Risk factors for osteoporosis were analyzed, and the incidence of osteoporosis in hypertension, coronary heart disease, and cerebral infarction populations of different severity was analyzed. Hypertension, coronary heart disease and cerebral infarction were the main risk factors for osteoporosis in the elderly. Incidence of osteoporosis in the double-vessel disease group and the three-vessel disease group was significantly higher than that in the single-vessel disease group. Incidence of osteoporosis was significantly higher in the three-vessel disease group than that in the double-vessel disease group (P<0.05). Incidence of osteoporosis was significantly higher in the moderate hypertension and severe hypertension groups than that in the mild hypertension group. Incidence of osteoporosis was significantly higher in patients with severe hypertension than that in the moderate hypertension group (P<0.05). Incidence of osteoporosis in patients with moderate cerebral infarction and severe cerebral infarction was significantly higher than that in the mild cerebral infarction group (P<0.05). Incidence of osteoporosis in patients with severe cerebral infarction was significantly higher than that in the moderate cerebral infarction group (P<0.05). The results indicated that there is a close correlation between senile osteoporosis and hypertension, coronary heart disease and cerebral infarction. Osteoporosis can be used as a predictor of early screening for hypertension, coronary heart disease and cerebral infarction in the elderly population.
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Affiliation(s)
- Xiaoying Hu
- The First Department of Geriatric Medicine, Harrison International Peace Hospital, Hengshui, Hebei 053000, P.R. China
| | - Shucan Ma
- The First Department of Geriatric Medicine, Harrison International Peace Hospital, Hengshui, Hebei 053000, P.R. China
| | - Caixia Yang
- The First Department of Geriatric Medicine, Harrison International Peace Hospital, Hengshui, Hebei 053000, P.R. China
| | - Weiwei Wang
- The First Department of Geriatric Medicine, Harrison International Peace Hospital, Hengshui, Hebei 053000, P.R. China
| | - Liman Chen
- The First Department of Geriatric Medicine, Harrison International Peace Hospital, Hengshui, Hebei 053000, P.R. China
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Abstract
OBJECTIVES Atherosclerosis and osteoporosis (OP) are common diseases in elderly individuals and may share common pathogenetic mechanisms. The aim of this study was to investigate the association between bone mineral density (BMD) and coronary artery calcium (CAC) in postmenopausal women. METHODS In this cross-sectional study, 186 postmenopausal women 50-80 years of age were included. BMD of the spine and femoral neck was measured by dual-energy X-ray absorptiometry. The coronary artery calcium score (CACS) was measured by multidetector computed tomography. RESULTS The study included postmenopausal women aged 65.6±7.3 years, 109 of whom (58.6%) showed CAC. Thirty-three (17.7%) of the patients were found to have OP in the lumbar spine and 83 (44.6%) had osteopenia, whereas in the femoral neck, 26 patients (14.0%) had OP and 87 patients (46.8%) had osteopenia. The mean CACS was 57.6±108.3 in normal status, 89.7±143.5 in OP, and 156.4±256.9 in osteopenia at the spine (P<0.05). The mean CACS was 43.2±89.9 in normal status, 126.9±180.3 in OP, and 198.2±301.2 in osteopenia at the femoral neck (P<0.05). Multivariable logistic regression analysis showed that BMD was an independent marker for an increased risk of developing CAC in postmenopausal women. The multiple regression model showed that T-scores were the independent predictors of CACS. CONCLUSION BMD identified on images from dual-energy X-ray absorptiometry were strongly related to multidetector computed tomography measures of CAC. This low-cost, minimal radiation technique used widely for OP screening is a promising marker of generalized coronary atherosclerosis.
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11
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Ferreira ECS, Bortolin RH, Freire-Neto FP, Souza KSC, Bezerra JF, Ururahy MAG, Ramos AMO, Himelfarb ST, Abreu BJ, Didone TVN, Pedrosa LFC, Medeiros AC, Doi SQ, Brandão-Neto J, Hirata RDC, Rezende LA, Almeida MG, Hirata MH, Rezende AA. Zinc supplementation reduces RANKL/OPG ratio and prevents bone architecture alterations in ovariectomized and type 1 diabetic rats. Nutr Res 2017; 40:48-56. [PMID: 28473060 DOI: 10.1016/j.nutres.2017.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 02/16/2017] [Accepted: 03/09/2017] [Indexed: 02/05/2023]
Abstract
Type 1 diabetes mellitus (T1DM) and estrogen deficiency are associated with several alterations in bone turnover. Zinc (Zn) is required for growth, development, and overall health. Zinc has been used in complementary therapy against bone loss in several diseases. We hypothesized that Zn supplementation represents a potential therapy against severe bone loss induced by the combined effect of estrogen deficiency and T1DM. We evaluated the protective effect of Zn against bone alterations in a chronic model of these disorders. Female Wistar rats were ramdomized into 3 groups (5 rats each): control, OVX/T1DM (ovariectomized rats with streptozotocin-induced T1DM), and OVX/T1DM+Zn (OVX/T1DM plus daily Zn supplementation). Serum biochemical, bone histomorphometric, and molecular analyses were performed. Histomorphometric parameters were similar between the control and OVX/T1DM+Zn groups, suggesting that Zn prevents bone architecture alterations. In contrast, the OVX/T1DM group showed significantly lower trabecular width and bone area as well as greater trabecular separation than the control. The OVX/T1DM and OVX/T1DM+Zn groups had significantly higher serum alkaline phosphatase activity than the control. The supplemented group had higher levels of serum-ionized calcium and phosphorus than the nonsupplemented group. The RANKL/OPG ratio was similar between the control and OVX/T1DM+Zn groups, whereas it was higher in the OVX/T1DM group. In conclusion, Zn supplementation prevents bone alteration in chronic OVX/T1DM rats, as demonstrated by the reduced RANKL/OPG ratio and preservation of bone architecture. The findings may represent a novel therapeutic approach to preventing OVX/T1DM-induced bone alterations.
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Affiliation(s)
- Elaine C S Ferreira
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Raul H Bortolin
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Francisco P Freire-Neto
- Department of Biochemistry, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Karla S C Souza
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - João F Bezerra
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Marcela A G Ururahy
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Ana M O Ramos
- Department of Clinical Pathology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Silvia T Himelfarb
- School of Pharmaceutical Science, University of São Paulo, São Paulo, Brazil
| | - Bento J Abreu
- Department of Morphology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Thiago V N Didone
- School of Pharmaceutical Science, University of São Paulo, São Paulo, Brazil
| | - Lucia F C Pedrosa
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Aldo C Medeiros
- Department of Clinical Medicine, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Sonia Q Doi
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - José Brandão-Neto
- Department of Clinical Medicine, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Rosário D C Hirata
- School of Pharmaceutical Science, University of São Paulo, São Paulo, Brazil
| | - Luciana A Rezende
- Department of Chemistry, University of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Maria G Almeida
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Mario H Hirata
- School of Pharmaceutical Science, University of São Paulo, São Paulo, Brazil
| | - Adriana A Rezende
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
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Ye C, Xu M, Wang S, Jiang S, Chen X, Zhou X, He R. Decreased Bone Mineral Density Is an Independent Predictor for the Development of Atherosclerosis: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0154740. [PMID: 27149062 PMCID: PMC4858264 DOI: 10.1371/journal.pone.0154740] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/18/2016] [Indexed: 01/11/2023] Open
Abstract
Background There is conflicting evidence regarding the association between decreased bone mineral density (BMD) and atherosclerosis. To this end, we performed a systematic review and meta-analysis to clarify the association. Methods To identify relevant studies, PubMed, Embase, and the Cochrane Library were systematically searched up to November 2015. All observational and comparative studies directly investigating the relationship between decreased BMD and clinical consequences of atherosclerotic vascular abnormalities, including carotid artery calcification (CAC), cardiovascular disease (CAD), and coronary artery disease (CAD) were obtained, without limitation of language or publication year. Results A total of 25 studies involving 10,299 patients were included. The incidence of atherosclerotic vascular abnormalities was significantly increased in low BMD patients, compared to patients with normal BMD (OR, 1.81, 95% CI [1.01, 2.19], p<0.00001)). Similar results were also observed for postmenopausal women (OR, 2.23, 95% CI [1.72, 2.89], p<0.00001). Subgroup analyses of osteopenia, osteoporosis, and normal BMD also revealed that the combined ORs for the incidence of atherosclerotic vascular abnormalities increased as BMD decreased. Of note, after adjusting for age, sex, body mass index (BMI) and other vascular risk factors, decreased BMD remained significantly associated with the incidence of atherosclerotic vascular abnormalities (OR, 2.96, 95% CI [2.25, 3.88], p < 0.00001). Conclusions Based on the results of this study, decreased BMD is an independent predictor for the development of atherosclerosis in elderly individuals. Moreover, the risk of atherosclerotic vascular abnormalities increased as BMD decreased. Future studies focusing on individuals with different severities of atherosclerosis and comorbidities are of interest.
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Affiliation(s)
- Chenyi Ye
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Mingyuan Xu
- Department of Plastic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Shengdong Wang
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Shuai Jiang
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Xi Chen
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Xiaoyu Zhou
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Rongxin He
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
- * E-mail:
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13
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Lechareas S, Yanni AE, Golemati S, Chatziioannou A, Perrea D. Ultrasound and Biochemical Diagnostic Tools for the Characterization of Vulnerable Carotid Atherosclerotic Plaque. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:31-43. [PMID: 26493239 DOI: 10.1016/j.ultrasmedbio.2015.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 08/10/2015] [Accepted: 09/04/2015] [Indexed: 06/05/2023]
Abstract
Stroke is a leading cause of morbidity and mortality worldwide, and characterization of vulnerable carotid plaque remains the spearhead of scientific research. Plaque destabilization, the key factor that induces the series of events leading to the clinical symptoms of carotid artery disease, is a consequence of complex mechanical, structural and biochemical processes. Novel imaging and molecular markers have been studied as predictors of disease outcome with promising results. The aim of this review is to present the current state of research on the association between ultrasound-derived echogenicity indices and blood parameters indicative of carotid plaque stability and activity. Bibliographic research revealed that there are limited available data. Among the biomarkers studied, those related to oxidative stress, lipoproteins and diabetes/insulin resistance are associated with echolucent plaques, whereas adipokines are associated with echogenic plaques. Biomarkers of inflammation and coagulation have not exhibited any conclusive relationship with plaque echogenicity, and it is not possible to come to any conclusion regarding calcification-, apoptosis- and neo-angiogenesis-related parameters because of the extremely limited bibliographic data.
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Affiliation(s)
- Simeon Lechareas
- Laboratory for Experimental Surgery and Surgery Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Amalia E Yanni
- Laboratory for Experimental Surgery and Surgery Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece.
| | - Spyretta Golemati
- Intensive Care Unit, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Achilles Chatziioannou
- Department of Interventional Radiology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Despoina Perrea
- Laboratory for Experimental Surgery and Surgery Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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14
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Wang YQ, Yang PT, Yuan H, Cao X, Zhu XL, Xu G, Mo ZH, Chen ZH. Low bone mineral density is associated with increased arterial stiffness in participants of a health records based study. J Thorac Dis 2015; 7:790-8. [PMID: 26101634 DOI: 10.3978/j.issn.2072-1439.2015.04.47] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/10/2015] [Indexed: 11/14/2022]
Abstract
AIMS Many epidemiological studies have shown that low bone mineral density (BMD) and atherosclerosis appear to be related. However, their precise correlation is not completely understood after full adjustment the shared confounders of atherosclerosis and bone metabolism. The aim of this cross-sectional study was to investigate the relationship between BMD and subclinical atherosclerosis in a healthy Chinese population and the difference in gender. METHODS The study population consisted of 2,487 subjects (1,467 men, 1,020 women) who participated in health check-up programs and were selected to be free of major diseases which might affect atherosclerosis and bone metabolism. Bone status was assessed by BMD in lumbar spine. The brachial-ankle PWV (baPWV) was assessed as a functional marker of atherosclerosis. The ankle-brachial index (ABI), carotid artery intima-media thickness (CIMT), estimated glomerular filtration rate (eGRF) and microalbuminuria were evaluated as indexes of structural markers of atherosclerosis. RESULTS After adjustment for risk factors, significant association was shown between baPWV and BMD in both genders (male: r=-0.084, P=0.035; female: r=-0.088, P=0.014). The correlation was stronger in females than in males, and in females, the correlation was stronger after menopause. Similarly, mean baPWV differed significantly according to the decreased BMD (normal BMD, Osteopenia, Osteoporosis). In contrast, no significant differences were observed for ABI, CIMT, eGFR or microalbuminuria with BMD. CONCLUSIONS Independent of confounding factors, low BMD is associated with the functional marker of subclinical atherosclerosis (increased baPWV), but not with structural markers (ABI, CIMT, eGFR or microalbuminuria) among healthy females and males.
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Affiliation(s)
- Ya-Qin Wang
- 1 Department of Healthy Management Center, 2 Department of Cardiology, 3 Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Ping-Ting Yang
- 1 Department of Healthy Management Center, 2 Department of Cardiology, 3 Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Hong Yuan
- 1 Department of Healthy Management Center, 2 Department of Cardiology, 3 Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Xia Cao
- 1 Department of Healthy Management Center, 2 Department of Cardiology, 3 Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Xiao-Ling Zhu
- 1 Department of Healthy Management Center, 2 Department of Cardiology, 3 Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Guo Xu
- 1 Department of Healthy Management Center, 2 Department of Cardiology, 3 Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Zhao-Hui Mo
- 1 Department of Healthy Management Center, 2 Department of Cardiology, 3 Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Zhi-Heng Chen
- 1 Department of Healthy Management Center, 2 Department of Cardiology, 3 Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
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15
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Gaudio A, Muratore F, Fiore V, Rapisarda R, Signorelli SS, Fiore CE. Decreased bone cortical density at the forearm in subjects with subclinical peripheral arterial disease. Osteoporos Int 2015; 26:1747-53. [PMID: 25672808 DOI: 10.1007/s00198-015-3057-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/28/2015] [Indexed: 12/14/2022]
Abstract
UNLABELLED The association between peripheral arterial disease (PAD) and low bone mass is controversial. In our study, peripheral quantitative computed tomography shows a reduction of cortical but not trabecular, bone mineral density (BMD) at the forearm, in patients with subclinical PAD. INTRODUCTION Some controversy exists regarding the association between peripheral arterial disease (PAD) and low bone mass. Previous studies have evaluated bone mineral density (BMD) in patients with subclinical PAD, with mixed results. Inconsistency of data may depend on the fact that most studies measured areal bone mineral density (aBMD) by Dual-energy-x ray absorptiometry (DXA). Because DXA cannot distinguish between cortical and trabecular compartments, we reasoned that a study aimed to establish whether these compartments were differentially affected by PAD status could give more information on the nature of this association. METHODS In this cross-sectional study, we used peripheral quantitative computed tomography (pQCT) to examine volumetric cortical and trabecular mineral density at the radius (vBMD) in a cohort of subjects with subclinical PAD as defined by ABI ≤0.90 and compared them with healthy subjects with no evidence of PAD. RESULTS Patients with subclinical PAD had significantly reduced cortical density (1101.0 ± 45.4 vs 1156.2 ± 51.3 mg/cm(3), p < 0.001) and cortical area (75.0 ± 20.9 vs 99.9 ± 18.2 mm(2), p < 0.001) than healthy subjects. Trabecular density (178.1 ± 47.9 vs 165.8 ± 29.6 mg/cm(3)) was not significantly different in the two groups. CONCLUSION Subclinical PAD induces a selective bone loss at the radius compartment, not identified by standard DXA, which seems to occur primarily at the cortical level.
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Affiliation(s)
- A Gaudio
- Department of Clinical and Experimental Medicine, Section of Metabolic Bone Disease, University of Catania, Clinica Medica OVE, Via Plebiscito 628, 95124, Catania, Italy
| | - F Muratore
- Department of Clinical and Experimental Medicine, Section of Metabolic Bone Disease, University of Catania, Clinica Medica OVE, Via Plebiscito 628, 95124, Catania, Italy
| | - V Fiore
- Department of Clinical and Experimental Medicine, Section of Vascular Medicine, Medical Angiology Unit, University of Catania, Garibaldi Hospital, Piazza S. Maria di Gesù 5, 95123, Catania, Italy
| | - R Rapisarda
- Department of Clinical and Experimental Medicine, Section of Metabolic Bone Disease, University of Catania, Clinica Medica OVE, Via Plebiscito 628, 95124, Catania, Italy
| | - S S Signorelli
- Department of Clinical and Experimental Medicine, Section of Vascular Medicine, Medical Angiology Unit, University of Catania, Garibaldi Hospital, Piazza S. Maria di Gesù 5, 95123, Catania, Italy
| | - C E Fiore
- Department of Clinical and Experimental Medicine, Section of Metabolic Bone Disease, University of Catania, Clinica Medica OVE, Via Plebiscito 628, 95124, Catania, Italy.
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London GM, Marchais SJ, Guérin AP, de Vernejoul MC. Ankle-brachial index and bone turnover in patients on dialysis. J Am Soc Nephrol 2014; 26:476-83. [PMID: 25231881 DOI: 10.1681/asn.2014020169] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An association between atherosclerosis and osteoporosis has been reported in several studies. This association could result from local intraosseous atherosclerosis and ischemia, which is shown by limb osteoporosis in patients with peripheral artery disease (PAD), but also could result from bidirectional communication between the skeleton and blood vessels. Systemic bone disorders and PAD are frequent in ESRD. Here, we investigated the possible interaction of these disorders. For 65 prevalent nondiabetic patients on hemodialysis, we measured ankle-brachial pressure index (ABix) and evaluated mineral and bone disorders with bone histomorphometry. In prevalent patients on hemodialysis, PAD (ABix<0.9 or >1.4/incompressible) was associated with low bone turnover and pronounced osteoblast resistance to parathyroid hormone (PTH), which is indicated by decreased double-labeled surface and osteoblast surface (P<0.001). Higher osteoblast resistance to PTH in patients with PAD was characterized by weaker correlation coefficients (slopes) between serum PTH and double-labeled surface (P=0.02) or osteoblast surface (P=0.03). The correlations between osteoclast number or eroded surface and serum mineral parameters, including PTH, did not differ for subjects with normal ABix and PAD. Common vascular risk factors (dyslipidemia, smoking, and sex) were similar for normal, low, and incompressible ABix. Patients with PAD were older and had high C-reactive protein levels and longer hemodialysis vintage. These results indicate that, in prevalent nondiabetic patients with ESRD, PAD associates with low bone turnover and pronounced osteoblast resistance to PTH.
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Affiliation(s)
- Gérard M London
- Department of Nephrology, Manhès Hospital, Fleury Mérogis, France; Department of Pharmacology, Georges Pompidou European Hospital, National Institute of Health and Medical Research U970, Paris, France; and
| | | | - Alain P Guérin
- Department of Pharmacology, Georges Pompidou European Hospital, National Institute of Health and Medical Research U970, Paris, France; and
| | - Marie-Christine de Vernejoul
- Lariboisiere Hospital, Vigot Petersen Centre, National Institute of Health and Medical Research U606, University Paris 7, Paris, France
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Albu A, Bondor CI, Crăciun AM, Fodor D. Circulating osteoprotegerin and asymptomatic carotid atherosclerosis in postmenopausal non diabetic women. Adv Med Sci 2014; 59:293-8. [PMID: 25240503 DOI: 10.1016/j.advms.2014.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 06/13/2014] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Osteoprotegerin (OPG) is a bone metabolism regulator but it is also involved in vascular calcification. Its role in the development of atherosclerosis is still a subject of debate. Postmenopausal women seem to have an increased risk for cardiovascular disease. The aim of the study is to evaluate the relationship between serum OPG and asymptomatic carotid atherosclerosis in postmenopausal non-diabetic women. MATERIAL/METHODS Carotid artery examination was performed in 100 postmenopausal women without diabetes mellitus and overt cardiovascular disease, using B-mode ultrasonography to determine the carotid intima-media thickness (CIMT) and the presence of plaques. Serum OPG was measured in all study participants and its relationship with clinical, biochemical and vascular parameters was evaluated. RESULTS CIMT correlated with age (r=0.45, p<0.001), years since menopause (r=0.30, p=0.003), abdominal circumference (r=0.25, p=0.01) and OPG (r=0.23, p=0.02). Carotid plaques correlated with age (p<0.001), obesity (p=0.03), abdominal circumference (p=0.03) and CIMT (p<0.001), but not with serum OPG (p=0.86). In regression analyses the independent predictors for CIMT were age (β=0.717, p<0.001), OPG (β=0.214, p=0.02), and years since menopause (β=-0.334, p=0.04) and for the presence of carotid plaques were obesity (p=0.04, OR=3.90), CIMT (p<0.001, OR=6408.86) and smoking (p=0.02, OR=687.93). CONCLUSION OPG is associated with cardiovascular risk factors, CIMT, but not with the presence of asymptomatic carotid plaques in non diabetic postmenopausal women. OPG may be a marker of cardiovascular risk.
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Ayaz T, Kirbas A, Durakoglugil T, Durakoglugil ME, Sahin SB, Sahin OZ, Kirvar A, Tasci F. The relation between carotid intima media thickness and serum osteoprotegerin levels in nonalcoholic fatty liver disease. Metab Syndr Relat Disord 2014; 12:283-9. [PMID: 24689950 DOI: 10.1089/met.2013.0151] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
AIM This study was designed to evaluate carotid intima media thickness (CIMT) and serum osteoprotegerin (OPG) levels in nonalcoholic fatty liver disease (NAFLD) in comparison to healthy controls and to investigate factors predicting the CIMT increase. MATERIALS AND METHODS A total of 60 outpatients [median (min-max) age 44.5 (24.0-65.0) years, 63.3% were females] diagnosed with NAFLD via ultrasonography performed during their admission to our hospital for any reason and 30 control subjects [median (min-max) age 39.5 (24.0-57.0) years, 73.3% were females] with normal liver echogenicity in ultrasonography were included in this study. Data on demographic characteristics, anthropometric measurements, biochemical and hematological tests, CIMT measurement, serum levels for OPG, and predictive factors for the CIMT increase were collected. RESULTS Median (min-max) CIMT [0.60 (0.40-1.10) vs. 0.50 (0.30-0.60), P<0.001) and OPG (pg/mL) [65.0 (18.1-272.8) vs. 32.0 (10.1-82.3), P<0.001] levels were significantly higher in NAFLD patients compared to controls, while there was a significant positive correlation between CIMT and serum OPG (r=0.42, P<0.001). Mean CIMT value was determined to increase significantly by 0.001 cm (P=0.001) for each 1 pg/mL of increase in OPG levels, by 0.103 cm (P<0.001) in case of concomitant NAFLD (P<0.001), and by 0.006 cm (P<0.001) for each 1 pg/mL of increase in urea levels. CONCLUSION Our findings indicate higher levels of serum OPG and CIMT in patients with NAFLD compared to controls along with a positive correlation between serum OPG and CIMT levels. High levels of serum OPG, presence of NAFLD, and high levels of serum urea seem to be the independent risk factors predictive for the CIMT increase.
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Affiliation(s)
- Teslime Ayaz
- 1 Department of Internal Medicine, Recep Tayyip Erdoğan University Faculty of Medicine , Rize, Turkey
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Fisher A, Srikusalanukul W, Davis M, Smith P. Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links. Clin Interv Aging 2013; 8:239-56. [PMID: 23460043 PMCID: PMC3585505 DOI: 10.2147/cia.s38856] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Considerable controversy exists regarding the contribution of mineral/bone metabolism abnormalities to the association between cardiovascular diseases (CVDs) and osteoporotic fractures. AIMS AND METHODS To determine the relationships between mineral/bone metabolism biomarkers and CVD in 746 older patients with hip fracture, clinical data were recorded and serum concentrations of parathyroid hormone (PTH), 25-hydroxyvitamin D, calcium, phosphate, magnesium, troponin I, parameters of bone turnover, and renal, liver, and thyroid functions were measured. RESULTS CVDs were diagnosed in 472 (63.3%) patients. Vitamin D deficiency was similarly prevalent in patients with (78.0%) and without (82.1%) CVD. The CVD group had significantly higher mean PTH concentrations (7.6 vs 6.0 pmol/L, P < 0.001), a higher prevalence of secondary hyperparathyroidism (SPTH) (PTH > 6.8 pmol/L, 43.0% vs 23.3%, P < 0.001), and excess bone resorption (urinary deoxypyridinoline corrected by creatinine [DPD/Cr] > 7.5 nmol/μmol, 87.9% vs 74.8%, P < 0.001). In multivariate regression analysis, SHPT (odds ratio [OR] 2.6, P = 0.007) and high DPD/Cr (OR 2.8, P = 0.016) were independent indictors of CVD. Compared to those with both PTH and DPD/Cr in the normal range, multivariate-adjusted ORs for the presence of CVD were 17.3 (P = 0.004) in subjects with SHPT and 9.7 (P < 0.001) in patients with high DPD/Cr. CVD was an independent predicator of SHPT (OR 2.8, P = 0.007) and excess DPD/Cr (OR 2.5, P = 0.031). CVD was predictive of postoperative myocardial injury, while SHPT was also an independent predictor of prolonged hospital stay and in-hospital death. CONCLUSION SHPT and excess bone resorption are independent pathophysiological mediators underlying the bidirectional associations between CVD and hip fracture, and therefore are important diagnostic and therapeutic targets.
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Affiliation(s)
- A Fisher
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia.
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Sheng L, Cao W, Cha B, Chen Z, Wang F, Liu J. Serum osteocalcin level and its association with carotid atherosclerosis in patients with type 2 diabetes. Cardiovasc Diabetol 2013; 12:22. [PMID: 23342952 PMCID: PMC3558414 DOI: 10.1186/1475-2840-12-22] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 01/19/2013] [Indexed: 12/21/2022] Open
Abstract
Objective To investigate the association of serum osteocalcin with carotid atherosclerosis in patients with type 2 diabetes. Methods We performed a cross-sectional community-based study in metropolitan area. Serum total osteocalcin was measured by radioimmunoassay in 382 men and 435 postmenopausal women. The carotid artery intima-media thickness (IMT) and carotid plaques (PLQ) were measured by B-mode ultrasound. Results The crude mean of serum osteocalcin concentrations were 4.52±2.43 ng/ml for men and 5.75±2.92 ng/ml for postmenopausal women (P <0.001), respectively. Osteocalcin levels were associated inversely with age, fasting serum insulin, HOMA-IR, ALT, triglycerides, total cholesterol, LDL- cholesterol, CRP (all P<0.001) and positively with adiponectin and HOMA-B (all P<0.05). After multiple adjustment, the odds ratios (ORs) were substantially higher risk for carotid plaques (OR 1.77 for 1 SD decrease in osteocalcin, 95% CI 1.23-2.76, p=0.005). These associations remained significant after further adjustment for potential confounder. Conclusions Serum osteocalcin levels is an independent risk factor for carotid atherosclerosis in patients with type 2 diabetes.
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Affiliation(s)
- Li Sheng
- Department of Endocrinology, Fudan University, Shanghai, China
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