Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links
A Fisher,1,3 W Srikusalanukul,1 M Davis,1,3 P Smith2,31Departments of Geriatric Medicine, 2Orthopaedic Surgery, The Canberra Hospital, 3Australian National University Medical School, Canberra, ACT, AustraliaBackground: Considerable controversy exists regarding the contribution of mineral/bone metabo...
Main Authors: | , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Dove Medical Press
2013-02-01
|
Series: | Clinical Interventions in Aging |
Subjects: | |
Online Access: | https://www.dovepress.com/cardiovascular-diseases-in-older-patients-with-osteoporotic-hip-fractu-peer-reviewed-article-CIA |
id |
doaj-156e630365504c239d41c697758b0c5c |
---|---|
record_format |
Article |
spelling |
doaj-156e630365504c239d41c697758b0c5c2020-11-25T02:36:03ZengDove Medical PressClinical Interventions in Aging1178-19982013-02-01Volume 823925612298Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional linksFisher ASrikusalanukul WDavis MSmith PA Fisher,1,3 W Srikusalanukul,1 M Davis,1,3 P Smith2,31Departments of Geriatric Medicine, 2Orthopaedic Surgery, The Canberra Hospital, 3Australian National University Medical School, Canberra, ACT, AustraliaBackground: Considerable controversy exists regarding the contribution of mineral/bone metabolism abnormalities to the association between cardiovascular diseases (CVDs) and osteoporotic fractures.Aims and methods: To determine the relationships between mineral/bone metabolism biomarkers and CVD in 746 older patients with hip fracture, clinical data were recorded and serum concentrations of parathyroid hormone (PTH), 25-hydroxyvitamin D, calcium, phosphate, magnesium, troponin I, parameters of bone turnover, and renal, liver, and thyroid functions were measured.Results: CVDs were diagnosed in 472 (63.3%) patients. Vitamin D deficiency was similarly prevalent in patients with (78.0%) and without (82.1%) CVD. The CVD group had significantly higher mean PTH concentrations (7.6 vs 6.0 pmol/L, P < 0.001), a higher prevalence of secondary hyperparathyroidism (SPTH) (PTH > 6.8 pmol/L, 43.0% vs 23.3%, P < 0.001), and excess bone resorption (urinary deoxypyridinoline corrected by creatinine [DPD/Cr] > 7.5 nmol/µmol, 87.9% vs 74.8%, P < 0.001). In multivariate regression analysis, SHPT (odds ratio [OR] 2.6, P = 0.007) and high DPD/Cr (OR 2.8, P = 0.016) were independent indictors of CVD. Compared to those with both PTH and DPD/Cr in the normal range, multivariate-adjusted ORs for the presence of CVD were 17.3 (P = 0.004) in subjects with SHPT and 9.7 (P < 0.001) in patients with high DPD/Cr. CVD was an independent predicator of SHPT (OR 2.8, P = 0.007) and excess DPD/Cr (OR 2.5, P = 0.031). CVD was predictive of postoperative myocardial injury, while SHPT was also an independent predictor of prolonged hospital stay and in-hospital death.Conclusion: SHPT and excess bone resorption are independent pathophysiological mediators underlying the bidirectional associations between CVD and hip fracture, and therefore are important diagnostic and therapeutic targets.Keywords: cardiovascular disease, hip fracture, PTH, 25(OH)D, secondary hyperparathyroidism, bone turnover, mineral metabolismhttps://www.dovepress.com/cardiovascular-diseases-in-older-patients-with-osteoporotic-hip-fractu-peer-reviewed-article-CIAcardiovascular diseasehip fracturePTH25(OH)vitamin Dsecondary hyperparathyroidismbone turnovermineral metabolism |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Fisher A Srikusalanukul W Davis M Smith P |
spellingShingle |
Fisher A Srikusalanukul W Davis M Smith P Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links Clinical Interventions in Aging cardiovascular disease hip fracture PTH 25(OH)vitamin D secondary hyperparathyroidism bone turnover mineral metabolism |
author_facet |
Fisher A Srikusalanukul W Davis M Smith P |
author_sort |
Fisher A |
title |
Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links |
title_short |
Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links |
title_full |
Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links |
title_fullStr |
Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links |
title_full_unstemmed |
Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links |
title_sort |
cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links |
publisher |
Dove Medical Press |
series |
Clinical Interventions in Aging |
issn |
1178-1998 |
publishDate |
2013-02-01 |
description |
A Fisher,1,3 W Srikusalanukul,1 M Davis,1,3 P Smith2,31Departments of Geriatric Medicine, 2Orthopaedic Surgery, The Canberra Hospital, 3Australian National University Medical School, Canberra, ACT, AustraliaBackground: Considerable controversy exists regarding the contribution of mineral/bone metabolism abnormalities to the association between cardiovascular diseases (CVDs) and osteoporotic fractures.Aims and methods: To determine the relationships between mineral/bone metabolism biomarkers and CVD in 746 older patients with hip fracture, clinical data were recorded and serum concentrations of parathyroid hormone (PTH), 25-hydroxyvitamin D, calcium, phosphate, magnesium, troponin I, parameters of bone turnover, and renal, liver, and thyroid functions were measured.Results: CVDs were diagnosed in 472 (63.3%) patients. Vitamin D deficiency was similarly prevalent in patients with (78.0%) and without (82.1%) CVD. The CVD group had significantly higher mean PTH concentrations (7.6 vs 6.0 pmol/L, P < 0.001), a higher prevalence of secondary hyperparathyroidism (SPTH) (PTH > 6.8 pmol/L, 43.0% vs 23.3%, P < 0.001), and excess bone resorption (urinary deoxypyridinoline corrected by creatinine [DPD/Cr] > 7.5 nmol/µmol, 87.9% vs 74.8%, P < 0.001). In multivariate regression analysis, SHPT (odds ratio [OR] 2.6, P = 0.007) and high DPD/Cr (OR 2.8, P = 0.016) were independent indictors of CVD. Compared to those with both PTH and DPD/Cr in the normal range, multivariate-adjusted ORs for the presence of CVD were 17.3 (P = 0.004) in subjects with SHPT and 9.7 (P < 0.001) in patients with high DPD/Cr. CVD was an independent predicator of SHPT (OR 2.8, P = 0.007) and excess DPD/Cr (OR 2.5, P = 0.031). CVD was predictive of postoperative myocardial injury, while SHPT was also an independent predictor of prolonged hospital stay and in-hospital death.Conclusion: SHPT and excess bone resorption are independent pathophysiological mediators underlying the bidirectional associations between CVD and hip fracture, and therefore are important diagnostic and therapeutic targets.Keywords: cardiovascular disease, hip fracture, PTH, 25(OH)D, secondary hyperparathyroidism, bone turnover, mineral metabolism |
topic |
cardiovascular disease hip fracture PTH 25(OH)vitamin D secondary hyperparathyroidism bone turnover mineral metabolism |
url |
https://www.dovepress.com/cardiovascular-diseases-in-older-patients-with-osteoporotic-hip-fractu-peer-reviewed-article-CIA |
work_keys_str_mv |
AT fishera cardiovasculardiseasesinolderpatientswithosteoporotichipfractureprevalencedisturbancesinmineralandbonemetabolismandbidirectionallinks AT srikusalanukulw cardiovasculardiseasesinolderpatientswithosteoporotichipfractureprevalencedisturbancesinmineralandbonemetabolismandbidirectionallinks AT davism cardiovasculardiseasesinolderpatientswithosteoporotichipfractureprevalencedisturbancesinmineralandbonemetabolismandbidirectionallinks AT smithp cardiovasculardiseasesinolderpatientswithosteoporotichipfractureprevalencedisturbancesinmineralandbonemetabolismandbidirectionallinks |
_version_ |
1724801719574986752 |