Osteoporosis In Patients With Carotid Atherosclerosis

Background and Objectives Individuals with cardiovascular (CV) disease have a higher risk of fragility fractures and individuals with low bone mineral density (BMD) have more CV events and higher mortality. In spite of sharing many risk factors, OP and atherosclerosis are thought to have common pathophysiological pathways. Chronic inflammation, oxidative stress, vitamin D, and homocysteine are among the putative mechanisms linking the two diseases. Our main objectives were to determine if BMD in patients with severe carotid atherosclerosis is different from the expected taking into account gender, age, and OP risk factors. Secondarily, we evaluated the association between atherosclerosis and BMD regardless of common risk factors and determined the relationship between homocysteine and 25OHD levels and BMD. Methods A clinical protocol for OP and CV risk factors evaluation, blood sample collection, Doppler ultrasound and dual-energy x-ray absorptiometry (DXA) were performed in a group of 73 patients undergoing carotid endarterectomy. Uni and multivariate analyses were carried out to evaluate the association between the two diseases, adjusting to relevant confounders and covariates whenever needed. Results The sample has 49 (67.1%) males, the average age is 69.6 ± 9.1 years. Carotid stenosis percentage is in average 85.2 ± 9.0% and BMD is 0.883 ± 0.148 g/cm 2 . The average t-score is -1.32 ± 1.23, which is significantly lower than one standard deviation (p = 0.039). 19.2% of patients have osteoporosis and 43.8% have osteopenia. BMD was not different from the expected for gender and age. 60.6% of patients have 25OHD deficiency, 31.8% have 25OHD insufficiency and 7.6% have normal values of 25OHD. Patients with lower BMD than normal did not differ from patients with normal BMD in any CV variable evaluated. There is no correlation between BMD and carotid stenosis percentage, homocysteine, or 25OHD. Homocysteine levels are statistically significantly associated with osteoporosis diagnosis (OR 1.159; 95% CI 1.001-1.343; p = 0.049), in a logistic regression adjusted for gender and age. Furthermore, homocysteine correlates with the 10-year probability of CV disease death. Conclusions Patients with severe carotid stenosis are significantly in the stage of osteopenia, but they don’t have a lower BMD than the expected taking into account gender and age. Homocysteine can be a marker for both cardiovascular disease and osteoporosis. Although there is no significant correlation between stenosis percentage and BMD and vitamin D levels, the relationship between these variables tends to be negative.