Association of Osteoporosis and CVD

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The association between low bone mineral density (LBMD) and atherosclerosis has been demonstrated in several studies. In the Rotterdam study, a population-based cohort study of 7,983 men and women over the age of 55 years, designed to assess risk factors for progression of atherosclerosis measured at multiple sites (van der Meer et al., 2003), and a cross-sectional analysis examining the association between BMD and peripheral arterial disease (PAD) was performed (van der Klift et al.,

2002). Data on BMD and PAD for 5,268 individuals (3,053 women and 2,215 men) were available, and the association between PAD and low BMD at the femoral neck was demonstrated in women, but not in men, suggesting estrogen deficiency as a common denominator between osteoporosis and PAD.

LBMD is also associated with early stages of atherosclerosis as measured by pulse wave velocity (PWV) (Hirose et al., 2003). In a study involving 7,865 Japanese individuals age 50 years or older, PWV, which reflects early atherosclerosis, was associated with osteo-sono assessment index (OSI), a measurement that correlates with BMD (Hirose et al., 2003). OSI was negatively correlated with PWV in both genders, and although this association was much stronger in women, it was independent of age and other risk factors for CVD. This association suggests a link between osteoporosis and CVD, particularly in its early stages (Hirose et al.,

2003). In another study of 236 premenopausal women aged 45 to 57 years, followed for nine years, the progression of atherosclerotic calcification of the aorta and metacarpal bone loss was demonstrated (Hak et al., 2000). In this prospective study, a cross-sectional analysis was also performed in postmenopausal women showing a graded inverse relationship between the extent of aortic calcification and metacarpal bone density (Hak et al., 2000).

LBMD was associated with increased mortality form CVD (Browner et al., 1991; von der Recke et al, 1999). In the study of osteoporotic fractures research group (Browner, 1991), 9704 ambulatory women aged 65 years and older were prospectively followed. LBMD at the proximal radius was strongly associated with increased mortality from stroke (relative risk 1.74; 95% CI 1.12-2.70). This association was not confounded by other risk factors for stroke such as age, hypertension, diabetes, smoking, or previous history of stroke (Browner et al., 1991). Another study involved two populations of healthy women: one group early after menopause with a mean age of 50 years and another later after menopause with a mean age of 70 years. In this study (Von der Recke, 1999), each decrease of one SD in bone mineral content was associated with a 2.3-fold increased risk of dying from CVD within 17 years of menopause. Elderly women (over 70 years of age) had a 1.8-fold increase of such a risk. These data indicate that low bone mineral content at menopause is a risk factor for CVD risk later in life (van der Recke et al., 1999).

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