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.