Is Osteoporosis linked with
Cardiovascular Disease?
Kwang-il, Kim, MD, PhD
Department of Internal Medicine,
Seoul National University College of Medicine,
Seoul National University Bundang Hospital
Osteoporosis vs Vascular calcification
Osteoporosis Vascular calcification
Association between Low Bone Mass
and Cardiovascular Mortality
Recke, Hansen, & Hassager, Am J Med 1999
BMD & CV mortality Fracture & CV mortality
Vascular Calcification
TM Doherty et al, EndoRev 2004
Aortic Calcification & the Risk of Osteoporosis
Schulz et al, JCEM 2004
QCT Volumetric Bone Mineral Density &
Vascular/Valvular Calcification (Framingham Study)
Chan JJ, et al. Journal of Bone and Mineral Research 2015
Bone mineral density &
incident cardiovascular diseases
Veronese N, et al. Journal of Bone and Mineral Research 2017
Atherosclerosis & bone mineralization
Demer & Tintut, ATVB 2014
ATVB 1997;17:680-687
Bone remodeling process
Lawrence G. Raisz, JCI 2005
Theories for vascular calcification
Fumiyuki Otsuka et al. Arterioscler Thromb Vasc Biol. 2014
Origin of osteoblast-type cells
Johnson et al, CirRes 2006
Role of circulating calcifying cell (CVC) in bone-vascular axis
Fadini et al, Circulation 2012
Thompson & Towler, NatRevEndo 2012
Relationships between the metabolic milieu,
genetics, arteriosclerosis & musculoskeletal disease
Thompson & Towler, NatRevEndo 2012
Age-dependent changes in cortical blood flow of long bones
Thompson & Towler, NatRevEndo 2012
Coronary calcium score & bone mineral density
0
50
100
150
200
Female
P=0.037
Male
P=0.741
Co
ron
ary
calc
ium
sco
re
Normal Osteopenia Osteoporosis
Coronary calcium score & age
according to the bone mineral density
0
150
300
450
600
750
0
150
300
450
600
750
Co
ron
ary
calc
ium
sco
re
50-54
(N=300)
55-59
(N=316)
60-64
(N=296)
65-69
(N=219)
70-74
(N=103)
≥ 75
(N=50)
50-54
(N=224)
55-59
(N=219)
60-64
(N=220)
65-69
(N=142)
70-74
(N=51)
≥ 75
(N=21)
P=0.643
P=0.971
P=0.336
P=0.236
P=0.629 P=0.749
P=0.819
P=0.196
P=0.285
P=0.489 P=0.552
P=0.518
Normal Reduced bone density
(Osteopenia /Osteoporosis)
Male Female
AGE AGE
Unadjusted and adjusted odds ratio for presence of any
coronary artery calcium (CACS > 0) with reduced bone
mineral density (osteopenia and osteoporosis)
Odds ratio P value 95% Confidence
interval
Model (1) 1.124 0.349 0.880 ~ 1.434
Model (2) 0.985 0.910 0.764 ~ 1.271
Model (3) 1.097 0.532 0.821 ~ 1.466
Female>
Odds ratio P value 95% Confidence
interval
Model (1) 1.925 <0.001 1.383 ~ 2.679
Model (2) 1.148 0.460 0.797 ~ 1.176
Model (3) 1.292 0.223 0.856 ~ 1.950
Model (1); unadjusted, Model (2); age-adjusted, Model (3); age & risk factors (hypertension,
diabetes mellitus, dyslipidemia, obesity, and smoking) adjusted
Male>
Gender Difference in
Bone Loss & Vascular Calcification
Dong-Hyeon Lee, Ho-Joong Youn, et al, KJC 2013
Lancet 2000; 355: 2185–88
JAMA Intern Med. 2015;175(2):171-177
Bisphosphonate Use and Prevalence of
Valvular/Vascular Calcification in Women
Elmariah et al. JACC 2010
Bisphosphonates & Risk of Cardiovascular Events
Kim DH, et al. PLOS One 2015
Myocardial Infarction & Stroke
with Use of Bisphosphonates
Kim DH, et al. PLOS One 2015
Summary
• Epidemiological studies verified a link between
osteoporosis and cardiovascular disease.
– Patients with osteoporosis are at higher risk for ischemic heart
disease and stroke and, on the other hand, patients with
peripheral arterial disease or ischemic heart disease have a
higher risk of osteoporotic fractures.
• However, further studies are required to investigate
the underlying mechanisms between osteoporosis
and cardiovascular disease.