Introduction
Osteoporosis is an orthopaedic disease characterized
by reduced bone mass and microstructural degradation of bone.
Osteoporosis can be divided into primary and secondary types, of
which primary osteoporosis is the main type in clinical practice
(1,2). Primary osteoporosis mainly affects the
elderly population. With the growth of aging population in China,
the incidence of osteoporosis also shows an increasing trend. The
risk of cardiovascular disease is increased with aging. Common
cardiovascular diseases in China include hypertension, coronary
heart disease, and cerebral infarction. Previous studies have
revealed that many elderly patients with osteoporosis are
associated with cardiovascular diseases such as hypertension,
coronary heart disease, and cerebral infarction. Osteoporosis and
various cardiovascular diseases have a common pathophysiological
basis (3,4). However, studies on the correlation
between senile osteoporosis and cardiovascular and cerebrovascular
diseases, especially the correlation between osteoporosis and the
severity of cardiovascular and cerebrovascular diseases are rare.
In this study, patients with hypertension, coronary heart disease
and cerebral infarction were used as the research subjects to
explore the correlation between senile osteoporosis and
cardiovascular disease. This study provides a theoretical basis for
screening high-risk groups of cardiovascular and cerebrovascular
diseases based on the diagnosis of early osteoporosis.
Patients and methods
Research subjects
A retrospective study on 600 elderly patients
hospitalized in Harrison International Peace Hospital (Hengshui,
China) from June 2014 to January 2017 was conducted. There were 207
cases of coronary heart disease, 102 cases of hypertension and 119
cases of cerebral infarction. Two hundreds and seven patients with
coronary heart disease including 120 males and 87 females, aged
60–81 years, with a mean age of 68.85±6.52 years. A hundred and two
patients with hypertension including 62 males and 40 females, aged
60–80 years, with a mean age of 67.73±6.58 years. A hundred and
nineteen cases of cerebral infarction including 60 males and 59
females, aged 61–79 years, with a mean age of 67.48±6.38 years.
Coronary heart disease was diagnosed according to the guidelines
for the diagnosis and treatment of chronic stable angina pectoris
established by the Chinese Medical Association Cardiovascular
Branch. Cerebral infarction was diagnosed according to the 2010
guidelines for the diagnosis and treatment of acute ischemic stroke
in China.
Inclusion criteria
Inclusion criteria were: i) patients with complete
medical records; ii) patients older than 60 years old; iii)
patients with no chronic wasting disease and malignant tumors, and
iv) patients with no autoimmune disease and infectious
diseases.
Exclusion criteria
Exclusion criteria were: i) patients with thyroid or
parathyroid disease; ii) patients with renal tubular and glomerular
diseases; iii) patients with diabetes or chronic liver disease; iv)
patients with bone metastases and osteoma; v) patients with a
history of abdominal surgery; vi) patients who were combined with
other serious physical diseases and other liver, kidney, and
endocrine diseases that affect bone metabolism; vii) patients who
were taking hormones or other drugs that affect bone metabolism;
viii) patients with a history of mental illness, and ix) patients
with incomplete medical record.
The study was approved by the Ethics Committee of
Harrison International Peace Hospital. Signed informed consents
were obtained from the patients or guardians.
Severity of coronary artery
disease
Left and right coronary arteries of patients with
coronary heart disease were imaged by contrast instrument. Severity
of coronary artery disease was evaluated according to the results
of coronary angiography. According to coronary artery lesions,
patients were divided into the single-vessel disease group, the
double-vessel disease group and the three-vessel disease group
(5).
Severity of hypertension
Blood pressure of hypertension patients was measured
according to standard blood pressure measurement method, and the
severity of hypertension was evaluated according to the measured
diastolic blood pressure and systolic blood pressure. Mild
hypertension: diastolic blood pressure is 90–99 mmHg and systolic
blood pressure is 140–159 mmHg. Moderate hypertension: diastolic
blood pressure is 100–109 mmHg and systolic blood pressure is
160–179 mmHg. Severe hypertension: diastolic blood pressure ≥110
mmHg and systolic blood pressure ≥180 mmHg (6).
Severity of cerebral infarction
The US National Institutes of Health Stroke Scale
was used to assess the severity of cerebral infarction patients.
Mild cerebral infarction: 2–4 points, moderate cerebral infarction:
5–20 points, severe cerebral infarction: >21 points (7).
Bone density measurement
Lumbar spine and left hip bone mineral density of
all subjects were measured using a dual-energy X-ray density meter,
and the results were compared with the peak bone mass (T) of
healthy individuals of the same sex. According to the Chinese
Medical Association's guidelines for clinical diagnosis and
treatment of osteoporosis, the criterion for the determination of
bone mass is T score. T<-1.0 indicates normal bone mass. Bone
mass is reduced when T>-1.0 - <-2.5. Osteoporosis was
diagnosed when T≥-2.5. According to the bone mineral density
measurement results of the study subjects and the diagnostic
criteria for osteoporosis, patients with hypertension, coronary
heart disease and cerebral infarction were divided into the
osteoporosis and non-osteoporosis groups (8).
Statistical analysis
Statistical analyses were performed using SPSS 19.0
statistical software (IBM Corp., Armonk, NY, USA). Count data were
expressed as % and the differences between groups were compared by
χ2 test. Factors affecting osteoporosis were analyzed by
Logistic regression analysis, and the test level was α=0.05.
Differences were statistically significant at P<0.05.
Results
Logistic regression analysis of senile
osteoporosis and cardiovascular and cerebrovascular diseases
With osteoporosis as a dependent variable, BMI,
blood glucose, triglyceride, cholesterol, high-density lipoprotein,
low-density lipoprotein, serum calcium, serum enzymes,
hypertension, coronary heart disease, cerebral infarction and other
factors were introduced into the two-class logistic model. Results
showed that hypertension, coronary heart disease and cerebral
infarction are the main risk factors for osteoporosis in the
elderly (Table I).
 | Table I.Logistic regression analysis of senile
osteoporosis and cardiovascular and cerebrovascular diseases. |
Table I.
Logistic regression analysis of senile
osteoporosis and cardiovascular and cerebrovascular diseases.
| Factors | β | SE | Wald | P-value | OR | 95% CI |
|---|
| BMI index | 1.277 | 0.670 | 2.811 | 0.091 | 3.090 | 0.827–11.543 |
| Blood glucose | 0.891 | 0.342 | 2.984 | 0.099 | 3.225 | 0.873–10.632 |
| Triglyceride | 1.046 | 0.568 | 2.764 | 0.064 | 2.536 | 0.672–9.621 |
| Cholesterol | 1.116 | 0.579 | 3.682 | 0.058 | 2.791 | 0.566–7.287 |
| High-density
lipoprotein | 1.268 | 0.683 | 2.578 | 0.068 | 2.686 | 0.673–9.632 |
| Low-density
lipoprotein | 1.673 | 0.883 | 2.637 | 0.082 | 3.872 | 0.737–6.782 |
| Serum calcium | 1.767 | 0.577 | 2.687 | 0.067 | 2.683 | 0.472–7.827 |
| Serum enzyme | 1.350 | 0.737 | 2.673 | 0.073 | 3.682 | 0.682–8.732 |
| Hypertension | 1.872 | 0.777 | 6.838 | 0.021 | 5.373 | 2.683–14.682 |
| Coronary heart
disease | 2.111 | 0.578 | 8.035 | 0.045 | 8.683 | 2.016–34.626 |
| Brain infarction | 1.597 | 0.745 | 4.037 | 0.044 | 4.286 | 1.376–20.863 |
Comparison of incidence of
osteoporosis in patients with coronary heart disease of different
severity
Incidence of osteoporosis in patients with different
severity of coronary heart disease was compared. Results showed
that the incidence of osteoporosis in the double-vessel disease and
three-vessel disease groups was significantly higher than that in
the single-vessel disease group (P<0.05). Incidence of
osteoporosis in the three-vessel disease group was significantly
higher than that in the double-vessel disease group (P<0.05)
(Table II).
| Table II.Comparison of incidence of
osteoporosis in patients with coronary heart disease of different
severity. |
Table II.
Comparison of incidence of
osteoporosis in patients with coronary heart disease of different
severity.
| Groups | Cases | Osteoporosis (cases
%) |
|---|
| Single-vessel
disease | 67 | 15/22.39 |
| Double-vessel
disease | 71 | 26/36.62a |
| Three-vessel
disease | 69 | 34/49.28a,b |
| χ2 |
|
10.643 |
| P-value |
|
0.005 |
Comparison of incidence of
osteoporosis in patients with hypertension of different
severity
Incidence of osteoporosis in patients with
hypertension of different severity was compared. Results showed
that incidence of osteoporosis was significantly higher in the
moderate hypertension and severe hypertension groups than that in
the mild hypertension group (P<0.05). Incidence of osteoporosis
was significantly higher in patients with severe hypertension than
that in the moderate hypertension group (P<0.05) (Table III).
| Table III.Comparison of incidence of
osteoporosis in patients with hypertension of different
severity. |
Table III.
Comparison of incidence of
osteoporosis in patients with hypertension of different
severity.
| Groups | Cases | Osteoporosis (cases
%) |
|---|
| Mild
hypertension | 31 | 8/25.81 |
| Moderate
hypertension | 40 | 14/35.00a |
| Severe
hypertension | 31 | 15/48.39a,b |
| χ2 |
|
7.257 |
| P-value |
|
0.027 |
Comparison of incidence of
osteoporosis in patients with different severity of cerebral
infarction
Incidence of osteoporosis in patients with different
severity of cerebral infarction was compared. Results showed that
incidence of osteoporosis in patients with moderate cerebral
infarction and severe cerebral infarction was significantly higher
than that in the mild cerebral infarction group (P<0.05).
Incidence of osteoporosis in patients with severe cerebral
infarction was significantly higher than that in patients with
moderate cerebral infarction (P<0.05) (Table IV).
| Table IV.Comparison of incidence of
osteoporosis in patients with different severity of cerebral
infarction. |
Table IV.
Comparison of incidence of
osteoporosis in patients with different severity of cerebral
infarction.
| Groups | Cases | Osteoporosis (cases
%) |
|---|
| Mild cerebral
infarction | 45 | 9/20.00 |
| Moderate cerebral
infarction | 33 | 12/36.36a |
| Severe cerebral
infarction | 41 | 20/48.78a,b |
| χ2 |
|
7.943 |
| P-value |
|
0.019 |
Discussion
Aging causes a series of changes in the human body.
Organ function reduction during aging leads to cardiovascular and
vascular diseases and osteoporosis, which are common diseases in
the elderly population. Epidemiological studies have shown a close
correlation between cardiovascular and cerebrovascular diseases and
osteoporosis (9,10). Incidence of cardiovascular and
cerebrovascular diseases such as hypertension, coronary heart
disease and cerebral infarction in the elderly osteoporosis group
is higher than that of the elderly population with normal bone
density. In addition, studies have shown that the use of low bone
density as a risk factor for cardiovascular and cerebrovascular
events and death may predict the occurrence of cardiovascular and
cerebrovascular diseases and the progress of the disease and is
more accurate than traditional risk factors such as smoking and
hyperlipidemia (11). Logistic
regression analysis in this study showed that hypertension,
coronary heart disease, and cerebral infarction were the main risk
factors for osteoporosis in the elderly. Our findings are
consistent with previous studies.
Hypertension is caused by a variety of factors such
as increased peripheral vascular resistance and increased cardiac
output. Renin-angiotensin-aldosterone system plays an important
role in the regulation of blood pressure in the human body. Some
scholars believe that renin-angiotensin-aldosterone system plays an
important role not only in the regulation of blood pressure, but
also in bone tissue. Moreover, renin-angiotensin-aldosterone system
is also present in bone tissue to regulate the production and
absorption of bone cells, and angiotensin I and angiotensin II can
also regulate the production and absorption of osteoclasts.
Angiotensin II can regulate the proliferation of vascular
endothelial cells and the formation of osteoblasts during bone
remodeling (12). Animal experiments
have shown that the level of angiotensin II in rats with essential
hypertension increases, while the level of BMD in the bone
decreases, the blood vessels have spasms and harden, apoptosis of
bone cells increases, the number of osteoblasts decreases, the
number of osteoclasts increases, bone mass decreases, and
characteristics of osteoporosis can be observed (13). Coronary heart disease is a heart
disease characterized by myocardial ischemia, hypoxia or necrosis
caused by coronary angiogenic atherosclerotic lesions, which lead
to stenosis or obstruction of blood vessels. Osteoporosis patients
have decreased conversion rate of osteoclasts to osteoblasts, which
in turn lead to increased osteolysis and increased calcium ion
concentration in blood circulation. High levels of calcium ions in
the blood circulation deposit on the intima of the inner wall of
the arterial vessel. Over time, atherosclerosis and calcification
of the vessel wall including the coronary artery may occur,
eventually leading to coronary heart disease (14). Cerebral infarction is caused by a
variety of causes of blood supply disorders in the local brain
tissue. Cerebral infarction leads to local tissue ischemia and
hypoxia, brain cell necrosis, and impaired neurological function.
Increased osteolysis in patients with osteoporosis leads to
increased calcium levels in the blood circulation. High levels of
calcium ions deposit on the intima of the inner wall of the
cerebral blood vessels and cause cerebral vascular atherosclerosis
and calcification, eventually leading to reduced blood supply to
the brain (15). In this study, it
was revealed that with the increase in the severity of
hypertension, coronary heart disease and cerebral infarction,
incidence of osteoporosis was significantly increased. These data
suggest that there is a close correlation between hypertension,
coronary heart disease and cerebral infarction and osteoporosis,
which can be used to predict the occurrence and development of
cardiovascular and cerebrovascular diseases.
In summary, there is a close correlation between
senile osteoporosis and hypertension, coronary heart disease and
cerebral infarction. Osteoporosis can be used as a predictor of
early screening for hypertension, coronary heart disease and
cerebral infarction in the elderly population.
Acknowledgements
Not applicable.
Funding
No funding was received.
Availability of data and materials
The datasets used and/or analyzed during the present
study are available from the corresponding author on reasonable
request.
Authors' contributions
XH drafted the manuscript. XH and SM recorded and
analyzed the severity of hypertension. WW and LC were responsible
for the severity of cerebral infarction analysis. SM and CY
assisted with bone density measurement. The final version was read
and approved by all the authors.
Ethics approval and consent to
participate
The study was approved by the Ethics Committee of
Harrison International Peace Hospital (Hengshui, China). Signed
informed consents were obtained from the patients or guardians.
Patient consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing
interests.
References
|
1
|
Ilić K, Obradović N and Vujasinović-Stupar
N: The relationship among hypertension, antihypertensive
medications, and osteoporosis: A narrative review. Calcif Tissue
Int. 92:217–227. 2013. View Article : Google Scholar : PubMed/NCBI
|
|
2
|
Kuipers AL, Miljkovic I, Carr JJ, Terry
JG, Nestlerode CS, Ge Y, Bunker CH, Patrick AL and Zmuda JM:
Association of circulating sclerostin with vascular calcification
in Afro-Caribbean men. Atherosclerosis. 239:218–223. 2015.
View Article : Google Scholar : PubMed/NCBI
|
|
3
|
Drechsler C, Evenepoel P, Vervloet MG,
Wanner C, Ketteler M, Marx N, Floege J, Dekker FW and Brandenburg
VM; NECOSAD Study Group, : High levels of circulating sclerostin
are associated with better cardiovascular survival in incident
dialysis patients: Results from the NECOSAD study. Nephrol Dial
Transplant. 30:288–293. 2015. View Article : Google Scholar : PubMed/NCBI
|
|
4
|
Drake MT, Clarke BL, Oursler MJ, Khosla S
and Cathepsin K: Cathepsin K inhibitors for osteoporosis: Biology,
potential clinical utility, and lessons learned. Endocr Rev.
38:325–350. 2017. View Article : Google Scholar : PubMed/NCBI
|
|
5
|
Chen SJ, Lin CS, Lin CL and Kao CH:
Osteoporosis is associated with high risk for coronary heart
disease: A population-based cohort study. Medicine (Baltimore).
94:e11462015. View Article : Google Scholar : PubMed/NCBI
|
|
6
|
Wolley MJ, Pimenta E, Calhoun D, Gordon
RD, Cowley D and Stowasser M: Treatment of primary aldosteronism is
associated with a reduction in the severity of obstructive sleep
apnoea. J Hum Hypertens. 31:561–567. 2017. View Article : Google Scholar : PubMed/NCBI
|
|
7
|
Fu HJ, Zhao LB, Xue JJ, Wu ZX, Huang YP,
Liu W and Gao Z: Elevated serum homocysteine (Hcy) levels may
contribute to the pathogenesis of cerebral infarction. J Mol
Neurosci. 56:553–561. 2015. View Article : Google Scholar : PubMed/NCBI
|
|
8
|
Lee SN, Cho JY, Eun YM, Song SW and Moon
KW: Associations between osteoporosis and coronary artery disease
in postmenopausal women. Climacteric. 19:458–462. 2016. View Article : Google Scholar : PubMed/NCBI
|
|
9
|
Lash RW, Nicholson JM, Velez L, Van
Harrison R and McCort J: Diagnosis and management of osteoporosis.
Prim Care. 36:181–198. 2009. View Article : Google Scholar : PubMed/NCBI
|
|
10
|
Gao M, Tang H, Zheng X, Zhou F and Lu W:
Association analysis of GWAS and candidate gene loci in a Chinese
population with coronary heart disease. Int J Clin Exp Med.
8:7497–7506. 2015.PubMed/NCBI
|
|
11
|
Kuru P, Akyüz G, Cerşit HP, Çelenlioğlu
AE, Cumhur A, Biricik Ş, Kozan S, Gökşen A, Özdemir M and Lüleci E:
Fracture history in osteoporosis: Risk factors and its effect on
quality of life. Balkan Med J. 31:295–301. 2014. View Article : Google Scholar : PubMed/NCBI
|
|
12
|
Shimizu H, Nakagami H, Osako MK, Hanayama
R, Kunugiza Y, Kizawa T, Tomita T, Yoshikawa H, Ogihara T and
Morishita R: Angiotensin II accelerates osteoporosis by activating
osteoclasts. FASEB J. 22:2465–2475. 2008. View Article : Google Scholar : PubMed/NCBI
|
|
13
|
Pennisi P, Russo E, Gaudio A, Veca R,
D'Amico F, Mangiafico RA, Laspina M, Tringali G, Signorelli SS and
Fiore CE: The association between carotid or femoral
atherosclerosis and low bone mass in postmenopausal women referred
for osteoporosis screening. Does osteoprotegerin play a role?
Maturitas. 67:358–362. 2010.PubMed/NCBI
|
|
14
|
Ye XL and Lu CF: Association of
polymorphisms in the leptin and leptin receptor genes with
inflammatory mediators in patients with osteoporosis. Endocrine.
44:481–488. 2013. View Article : Google Scholar : PubMed/NCBI
|
|
15
|
Zhang J, Xu R, Li Z and Zha W: Cerebral
infarction due to malposition of cervical pedicle screw: A case
report. Medicine (Baltimore). 97:e99372018. View Article : Google Scholar : PubMed/NCBI
|
