Endocrine

, Volume 23, Issue 1, pp 1–10

Osteoporosis and cardiovascular disease

Brittle bones and boned arteries, is there a link?
  • Samy I. McFarlane
  • Ranganath Muniyappa
  • John J. Shin
  • Gul Bahtiyar
  • James R. Sowers
Review

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, bisphosphonates, 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.

Key Words

Osteoporosis cardiovascular disease aging atherosclerosis bone mineral density risk factors 

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Copyright information

© Humana Press Inc 2004

Authors and Affiliations

  • Samy I. McFarlane
    • 1
    • 2
  • Ranganath Muniyappa
    • 1
    • 2
  • John J. Shin
    • 1
    • 2
  • Gul Bahtiyar
    • 1
    • 2
  • James R. Sowers
    • 3
  1. 1.Department of Internal Medicine, Division of EndocrinologySUNY-DownstateBrooklyn
  2. 2.Kings County Hospital CenterBrooklyn
  3. 3.University of Missouri and the H.S. Truman Veterans Affairs Medical CenterColumbia
  4. 4.Division of Endocrinology, Diabetes and Hypertension. Director, Osteoporosis Diagnostic CenterSUNY-Downstate Health Science Center at BrooklynBrooklyn

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