Decreased bone cortical density at the forearm in subjects with subclinical peripheral arterial disease
- 180 Downloads
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.
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.
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.
Patients with subclinical PAD had significantly reduced cortical density (1101.0 ± 45.4 vs 1156.2 ± 51.3 mg/cm3, p < 0.001) and cortical area (75.0 ± 20.9 vs 99.9 ± 18.2 mm2, p < 0.001) than healthy subjects. Trabecular density (178.1 ± 47.9 vs 165.8 ± 29.6 mg/cm3) was not significantly different in the two groups.
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.
KeywordsCortical density PAD pQCT RANKL
Conflicts of interest
- 2.Farhat GN, Strotmeyer ES, Newman AB, Sutton-Tyrrel K, Bauer DC, Harris T, Johnson KC, Toaffe DR, Cauley JA (2006) Volumetric and areal bone mineral density measures are associated with cardiovascular disease in older men and women: the health, aging, and bone composition study. Calcif Tissue Int 79:102–11PubMedCrossRefGoogle Scholar
- 4.Hampson G, Edwards S, Conroy S, Blake GM, Fogelman I, Frost ML (2013) The relationship between inhibitors of the Wnt signaling pathway (Dickkopf-1 (DKK1) and Sclerostin), bone mineral density, vascular calcification and arterial stiffness in post-menopausal women. Bone 56:42–7PubMedCrossRefGoogle Scholar
- 6.Collins TC, Ewing SK, Diem SJ, Taylor BC, Orwoll ES, Cummings SR, Strotmeyer ES, Ensrud KE, Osteoporotic Fractures in Men (MrOS) Study Group (2009) Peripheral arterial disease is associated with higher rates of hip bone loss and increased fracture risk in older men. Circulation 119(17):2305–12PubMedCentralPubMedCrossRefGoogle Scholar
- 10.London GM, Marchais SJ, Guérin AP, de Vernejoul MC (2014) Ankle-brachial index and bone turnover in patients on dialysis. J Am Soc Nephrol. 2014 Sep 17. pii: ASN.2014020169Google Scholar
- 18.Pennisi P, Russo E, Gaudio A, Veca R, D’Amico F, Mangiafico RA, Laspina M, Tringali G, Signorelli SS, Fiore CE (2010) The association between carotid or femoral atheriosclerosis and low bone mass in postmenopausal women referred for osteoporosis screening. Does osteoprotegerin play a role? Maturitas 67:358–62PubMedCrossRefGoogle Scholar
- 21.Grampp S, Lang PL, Jergas M, GlÜer CC, Mathur A, Engelke K, Genant HK (1995) Assessment of the skeletal status by peripheral quantitative computed tomography of the forearm: short-term precision in vivo and comparison to dual X-ray absorptiometry. J Bone Miner Res 10:1566–76PubMedCrossRefGoogle Scholar
- 26.Winterhalder L, Eser P, Widmer J, Villiger PM, Aeberli D (2012) Changes in volumetric BMD of radius and tibia upon antidepressants drug administration in young depressive patients. J Muskuloskelet Neuronal Interact 12:224–9Google Scholar
- 27.Gaudio A, Pennisi P, Muratore F, Bertino G, Ardiri A, Pulvirenti I, Tringali G, Fiore CE (2012) Reduction of volumetric bone mineral density in postmenopausal women with hepatitis C virus-correlated chronic liver disease: a peripheral quantitative computerized tomography (pQCT) study. Eur J Int Med 23:656–60CrossRefGoogle Scholar
- 31.Kassanos D, Trakakis E, Baltos CS, Papakonstantinou O, Simeonidis G, Salamalakis G, Grammatikakis I, Basios G, Labos G, Skarantavos G, Balanika A (2010) Augmentation of cortical bone mineral density in women with polycystic ovary syndrome: a peripheral quantitative computed tomography (pQCT) study. Human Rep 25:2107–14CrossRefGoogle Scholar
- 44.Crisafulli A, Micari A, Altavilla D, Saporito F, Sardella A, Passaniti M, Raffa S, D’Anneo G, Mioni F, Arrigo F, Squadrito F (2005) Serum levels of osteoprotegerin and RANKL inpatients with ST elevation acute myocardial infarction. Clin Sci (London) 209:389–95Google Scholar