Skip to main content
SpringerLink
Log in

Hypovitaminosis D, impaired bone turnover and low bone mass are common in patients with peripheral arterial disease

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Hypovitaminosis D is common in patients with peripheral arterial disease (PAD). Subsequent secondary hyperparathyroidism and osteomalacia contribute to bone pain and myalgias, and so aggravate clinical symptoms of claudication. We evaluated 95 out of 297 patients with angiographically confirmed PAD stages II (pain in the calves and/or thighs only during exercise) or IV (history of, or presence of local ulcers) and compared them with 44 matched healthy controls regarding their medical history, bone density measurements of the femoral neck and calcaneal bone ultrasound. Bone pain, myalgias and mobility restriction as well as routine laboratory parameters, serum vitamin D [25(OH)D], crosslaps (CTX), parathyroid hormone (PTH), osteocalcin (OC) and alkaline phosphatase (AP) were recorded and analysed. 25(OH)D was significantly lower in PAD IV patients (9.6±4.6 ng/ml, P<0.0001) as compared to PAD II stages and controls (19.0±7.6 and 19.1±9.1 ng/ml), paralleled by lower serum calcium [2.24±0.02 mmol/l, P=0.0002 versus PAD II (2.36±0.02) and P<0.0001 versus controls (2.39±0.02)] and higher iPTH serum levels (66.3±3.6 pg/ml, P<0.0001) as compared to PAD II patients (45.3±3.5) and healthy controls (38.5±2.4). Alkaline phosphatase and serum crosslaps values were significantly higher and age-adjusted bone density and bone ultrasound measurements significantly lower in PAD IV patients, who were also twice as likely to have bone pain and myalgias as PAD II patients. Bone ultrasound measurements correlated significantly with both clinical severity and pain as well as serological parameters of bone metabolism. Underlying PAD has a significant impact on bone density and metabolism as well as on bone and muscular pain. Patients with PAD are at high risk for osteoporosis and osteomalacia and should be regularly monitored and treated for their vitamin D deficiencies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Fahrleitner A, Dobnig H, Obernosterer A, Pilger E, Leb G, Weber K, Kudlacek S, Obermayer-Pietsch BM (2002) Vitamin D deficiency and secondary hyperparathyroidism are common complications in patients with peripheral arterial disease. J Gen Int Med 17:663–669

    Article  Google Scholar 

  2. Holick MF (2002) Sunlight and vitamin D: both good for cardiovascular health. J Gen Int Med 17:733–735

    Article  Google Scholar 

  3. Chapuy MC, Schott AM, Garnero P, Hans D, Delmas PD, Meunier PJ and the EPIDOS Study Group (1996) Healthy elderly French women living at home have secondary hyperparathyroidism and high bone turnover in winter. J Clin Endocrinol Metab 81:1129–1133

    Article  CAS  PubMed  Google Scholar 

  4. Harris SS, Soteriades E, Coolidge JA, Mudgal S, Dawson-Hughes B (2000) Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population. J Clin Endocrinol Metab 85:4125–130

    Article  CAS  PubMed  Google Scholar 

  5. Isaia G, Giorgino R, Rini GB, Bevilacqua M, Maugeri D, Adami S (2003) Prevalence of hypovitaminosis D in elderly women in Italy: clinical consequences and risk factors. Osteoporos Int 14:577–582

    Article  CAS  PubMed  Google Scholar 

  6. Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501

    Article  CAS  PubMed  Google Scholar 

  7. Thomas MK, Lloyd-Jones DM, Thadhani RI et al. (1998) Hypovitaminosis D in medical inpatients. N Engl J Med 338:777–783

    Article  CAS  PubMed  Google Scholar 

  8. Johnell O, Oden A, De Laet C, Garnero P, Delmas PD, Kanis JA (2002) Biochemical indices of bone turnover and the assessment of fracture probability. Osteoporos Int 13:523–526

    Article  CAS  PubMed  Google Scholar 

  9. Garnero P, Dargent-Molina P, Hans D, Schott AM, Breart G, Meunier PJ, Delmas PD (1998) Do markers of bone resorption add to bone mineral density and ultrasonographic heel measurement for the prediction of hip fracture in elderly women? The EPIDOS prospective study. Osteoporos Int 8:563–569

    Article  CAS  PubMed  Google Scholar 

  10. van der Klift M, Pols HA, Hak AE, Witteman JC, Hofman A, de Laet CE (2002) Bone mineral density and the risk of peripheral arterial disease: the Rotterdam Study. Calcif Tissue Int 70:443–449

    Article  PubMed  Google Scholar 

  11. Tanko LB, Bagger YZ, Christiansen C (2003) Low bone mineral density in the hip as a marker of advanced atherosclerosis in elderly women. Calcif Tissue Int 73:15–20

    Article  CAS  PubMed  Google Scholar 

  12. Laroche M, Moulinier L, Leger P, Lefebvre D, Mazieres B, Boccalon H (2003) Bone mineral decrease in the leg with unilateral chronic occlusive arterial disease. Clin Exp Rheumatol 21:103–106

    CAS  PubMed  Google Scholar 

  13. Pennisi P, Signorelli SS, Riccobene S, Celotta G, Di Pino L, La Malfa T, Fiore CE (2003) Low bone density and abnormal bone turnover in patients with atherosclerosis of peripheral vessels. Osteoporos Int 198:1550–1559

    Google Scholar 

  14. Kudlacek S, Schneider B, Peterlik M, Leb G, Klaushofer K, Weber K, Woloszczuk W, Willvonseder R, Austrian Study Group on Normative Values of Bone Metabolism (2003) Assessment of vitamin D and calcium status in healthy adult Austrians. Eur J Clin Invest 33:323–331

    CAS  PubMed  Google Scholar 

  15. Bischoff H, Stahelin HB, Vogt P et al. (1999) Immobility as a major cause of bone remodelling in residents of a long-stay geriatric ward. Calcif Tissue Int 64:485–489

    Article  CAS  PubMed  Google Scholar 

  16. McDermott MM, Kerwin DR, Liu K et al. (2001) Prevalence and significance of unrecognised lower extremity peripheral arterial disease in general medicine practice. J Gen Int Med 16:384–390

    Article  CAS  Google Scholar 

  17. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767

    Article  PubMed  Google Scholar 

  18. Krieg MA, Cornuz J, Ruffieux C, Sandini L, Buche D, Dambacher MA, Hartl F, Hauselmann HJ, Kraenzlin M, Lippuner K, Neff M, Pancaldi P, Rizzoli R, Tanzi F, Theiler R, Tyndall A, Wimpfheimer K, Burckhardt P (2003) Comparison of three bone ultrasounds for the discrimination of subjects with and without osteoporotic fractures among 7562 elderly women. J Bone Miner Res 18:1261–1266

    CAS  PubMed  Google Scholar 

  19. Parfitt AM (1998) Osteomalacia and related disorders. In: Avioli LV, Krane SM (1998) Metabolic bone disease, 3rd edn. Academic Press, San Diego, Calif., pp. 327–386

  20. Chapuy MC, Arlot ME, Duboeuf F (1992) Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med 327:1637–1642

    CAS  PubMed  Google Scholar 

  21. Glerup H, Mikkelsen K, Poulsen L et al. (2000) Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement. Calcif Tissue Int 66:419–424

    Article  CAS  PubMed  Google Scholar 

  22. Bruyere O, Collette J, Delmas P, Rouillon A, Roux C, Seidel L, Richy F, Reginster JY (2003) Interest of biochemical markers of bone turnover for long-term prediction of new vertebral fracture in postmenopausal osteoporotic women. Maturitas 25:259–265

    Article  Google Scholar 

  23. Pedrera JD, Canal ML, Carvajal J, Postigo S, Villa LF, Hernandez ER, Rico H (2000) Influence of vitamin D administration on bone ultrasound measurements in patients on anticonvulsant therapy. Eur J Clin Invest 30:895–899

    Article  CAS  PubMed  Google Scholar 

  24. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE (1997) Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 337:670–676

    Article  CAS  PubMed  Google Scholar 

  25. Pfeifer M, Begerow B, Minne HW, Abrams C, Nachtigall D, Hansen C (2000) Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. J Bone Miner Res 15:1113–1118

    CAS  PubMed  Google Scholar 

  26. Meunier PJ, Chapuy MC, Arlot ME, Delmas PD, Duboeuf F (1994) Can we stop bone loss and prevent hip fractures in the elderly. Osteoporos Int 4:71–76

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Division of Endocrinology, University Medical Center, Graz, Austria

    Astrid Fahrleitner-Pammer, Harald Dobnig, Hans Peter Dimai, Georg Leb & Barbara M. Obermayer-Pietsch

  2. Division of Angiology, University Medical Center, Graz, Austria

    Andrea Obernosterer & Ernst Pilger

  3. Department of Internal Medicine, Krankenhaus der Barmherzigen Brüder, Vienna, Austria

    Stefan Kudlacek

Authors
  1. Astrid Fahrleitner-Pammer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Obernosterer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ernst Pilger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Harald Dobnig
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hans Peter Dimai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Georg Leb
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stefan Kudlacek
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Barbara M. Obermayer-Pietsch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Barbara M. Obermayer-Pietsch.

Additional information

S. Kudlacek represents the Austrian Study Group on Normative Values of Bone Metabolism.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fahrleitner-Pammer, A., Obernosterer, A., Pilger, E. et al. Hypovitaminosis D, impaired bone turnover and low bone mass are common in patients with peripheral arterial disease. Osteoporos Int 16, 319–324 (2005). https://doi.org/10.1007/s00198-004-1693-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-004-1693-3

Keywords

Search

Navigation