Received December 12, 2016
Accepted for publication February 16, 2017
Osteoporosis and atherosclerosis are chronic systemic
diseases and major public health problems worldwide. They are
both important causes of morbidity and mortality in aging men.
Although the incidences of osteoporosis and atherosclerosis
increase with age, there is growing evidence that the
coincidental occurrence of both diseases may be independent
of age (1). In healthy individuals, the relationship between
atherosclerosis and bone mass has not been extensively studied.
Most studies are conducted in postmenopausal women or
subjects with cardiovascular disease, while only few studies
studied the relationship between atherosclerosis and bone
mineral density (BMD) in men with inconsistent results
(2-5). On the other hand, it is widely recognized that lifestyle
measures and measures aimed at reducing adverse effects on
bone of drugs and diseases have to be recommended throughout
life in everyone (6).
The current evidence indicates that individuals with
prevalent (sub)clinical cardiovascular disease (CVD) are at
increased risk for bone loss and subsequent fractures (7).
Measurement of the intimal media thickness (IMT) in the
carotid arteries is a non-invasive, sensitive and reproducible
technique for identifying subclinical cardiovascular disease.
In postmenopausal women most of the studies reported an
association of increased IMT with low bone density. In the one
study that included men, findings were in line with the results
in women (2).
Arterial wall calcification would be expected to increase
arterial stiffness. Pulse wave velocity (PWV) and augmentation
index (Aix) are measurements of arterial stiffness and both
predictors of adverse cardiovascular events (8, 9). Bone loss is
associated with increased arterial stiffness in postmenopausal
females and hemodialysis patients (10-12). Few studies have
addressed the question of an association between osteoporosis
and arterial stiffness in healthy men (13, 14). Findings were not
consistent, which may be due to the use of suboptimal measures
of arterial stiffness and BMD (15).
Atherosclerosis and osteoporosis could be linked through
common risk factors or a shared pathophysiological
mechanism. Possible candidates of linking factors are low grade
inflammation insulin sensitivity. Markers of inflammation,
such as high sensitivity C-reactive protein (hsCRP) have been
associated with cardiovascular mortality in both sexes (15) and
levels of hsCRP were associated with lower BMD (16, 17). In
patient with type 1 diabetes BMD is lower than in non-diabetic
subjects. In patients with type 2 diabetes bone mineral density
is similar to or higher than in non-diabetic subjects (18).
The aim of this study is to investigate the relationship
between atherosclerosis measured by subclinical CVD (carotid
IMT)and arterial stiffness (PWV and AIX) and BMD in
independently living men aged 40 to 80 years. In addition, we
LINKS BETWEEN ATHEROSCLEROSIS AND OSTEOPOROSIS IN MIDDLE
AGED AND ELDERLY MEN
F. VAN DEN BOS
, M.H. EMMELOT-VONK
, Y.T. VAN DER SCHOUW
1. HagaHospital, department of internal medicine. Leyweg 275, 2545 CH, The Haque, The Netherlands; 2. University Medical Center Utrecht, Department of Geriatric medicine, PO Box
85500, 3GA Utrecht, The Netherlands; 3. Julius Center for Health sciences and Primary Care, University Medical Center of Utrecht, PO box 85500; 3508 GA Utrecht, The Netherlands.
Corresponding author: Frederiek van den Bos, HagaHospital, department of internal medicine. Leyweg 275, 2545 CH, The Haque, The Netherlands, 0031-70-2102917.
Abstract: Background: Although the incidences of osteoporosis and atherosclerosis increase with age, there
is growing evidence that the coincidental occurrence of both diseases may be independent of age. In general,
studies in men are scarce and results are inconsistent. Objective: to investigate the relationship between
atherosclerosis and bone mineral density, and the influence of insulin sensitivity and low grade inflammation on
this relationship in 332 men without CVD. Methods: Aortic Pulse wave velocity (PWV), augmentation index
(AIX) and measurements of carotid intima media thickness (CIMT) were assessed. BMD measurements were
performed with dual-X-ray absorptiometry (DEXA), subcutaneous fat by ultrasonography. Serum concentrations
of lipids, hsCRP, glucose and insulin were measured. Insulin sensitivity was calculated by use of the quantitative
insulin sensitivity (QUICKI). We used multivariate linear regression models to examine the association of
hsCRP, insulin sensitivity, PWV, Aix, CIMT with BMD. Results: A higher CIMT was significantly associated
with higher BMD after multivariate adjustment (ß 99.7; p=0.02). Further adjustment for weight attenuated the
estimates towards non-significant. No association was found between PWV or AIX and BMD. Lower insulin
sensitivity was associated with higher BMD (ß -645.1; p<0.01). After adjustment for weight this association was
no longer significant. A similar effect was seen for the association between hsCRP and BMD. Conclusion: In
this population of healthy, non-obese, men without a history of cardiovascular disease the positively association
between cardiovascular parameters and BMD was mainly explained by weight, suggesting that in this population
weight plays a protective role in the development of osteoporosis.
Key words: Osteoporosis, bone mineral density, cardiovascular diseases, atherosclerosis, inflammation.
© Serdi and Springer-Verlag International SAS, part of Springer Nature
J Nutr Health Aging. 2018;22(6):639-644
Published online April 30, 2018, http://dx.doi.org/10.1007/s12603-018-1039-z