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Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links.

Fisher A, Srikusalanukul W, Davis M, Smith P - Clin Interv Aging (2013)

Bottom Line: Vitamin D deficiency was similarly prevalent in patients with (78.0%) and without (82.1%) CVD.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia. alex.fisher@act.gov.au

ABSTRACT

Background: 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.

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Odds ratios for presence of cardiovascular disease in older patients with hip fracture according to serum parathyroid hormone and urinary deoxypyridinoline levels.Notes: High levels were defined as exceeding the upper limits of normal range: >6.8 pmol/L for serum PTH and >7.5 nmol/μmol for urinary DPD/Cr. Adjustment was made for age, sex, smoking status, alcohol consumption, dementia, hip-fracture type, eGFR < 60 mL/minute/1.73 m2, 25(OH)D < 50 nmol/L and albumin < 33 g/L. The odds ratios compared to the reference group (both PTH and DPD/Cr in the normal range) are shown.Abbreviations: PTH, parathyroid hormone; DPD/Cr, deoxypyridinoline corrected by urinary creatinine; 25(OH)D, 25-hydroxyvitamin D; eGFR, estimated glomerular filtration rate.
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f1-cia-8-239: Odds ratios for presence of cardiovascular disease in older patients with hip fracture according to serum parathyroid hormone and urinary deoxypyridinoline levels.Notes: High levels were defined as exceeding the upper limits of normal range: >6.8 pmol/L for serum PTH and >7.5 nmol/μmol for urinary DPD/Cr. Adjustment was made for age, sex, smoking status, alcohol consumption, dementia, hip-fracture type, eGFR < 60 mL/minute/1.73 m2, 25(OH)D < 50 nmol/L and albumin < 33 g/L. The odds ratios compared to the reference group (both PTH and DPD/Cr in the normal range) are shown.Abbreviations: PTH, parathyroid hormone; DPD/Cr, deoxypyridinoline corrected by urinary creatinine; 25(OH)D, 25-hydroxyvitamin D; eGFR, estimated glomerular filtration rate.

Mentions: Further, we examined the unique and combined effects of abnormally high PTH and DPD/Cr levels as indicators of presence of CVD (Table 6). Compared to subjects with normal serum PTH and urinary DPD/Cr levels (reference group), the age-and sex-adjusted OR for CVD (model 1) was significantly greater in patients with high DPD/Cr and normal PTH levels (OR 4.26, P = 0.005), but the highest risk of CVD was in patients with elevated PTH and both normal (OR 10.27, P = 0.004) and high DPD/Cr (OR 7.61, P < 0.001). After adjustment for seven additional factors was made, the OR for the presence of CVD further increased (model 2, Table 6): 17.32 in patients only with SHPT, 9.68 in patients with SHPT and high DPD/Cr, and 5.33 in subjects only with excess bone resorption. These associations are displayed in Figure 1. In total, the OR for presence of CVD among HF patients with SHPT or excess bone resorption compared to those with both parameters in the normal range was 7.54 (Table 6).


Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links.

Fisher A, Srikusalanukul W, Davis M, Smith P - Clin Interv Aging (2013)

Odds ratios for presence of cardiovascular disease in older patients with hip fracture according to serum parathyroid hormone and urinary deoxypyridinoline levels.Notes: High levels were defined as exceeding the upper limits of normal range: >6.8 pmol/L for serum PTH and >7.5 nmol/μmol for urinary DPD/Cr. Adjustment was made for age, sex, smoking status, alcohol consumption, dementia, hip-fracture type, eGFR < 60 mL/minute/1.73 m2, 25(OH)D < 50 nmol/L and albumin < 33 g/L. The odds ratios compared to the reference group (both PTH and DPD/Cr in the normal range) are shown.Abbreviations: PTH, parathyroid hormone; DPD/Cr, deoxypyridinoline corrected by urinary creatinine; 25(OH)D, 25-hydroxyvitamin D; eGFR, estimated glomerular filtration rate.
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3585505&req=5

f1-cia-8-239: Odds ratios for presence of cardiovascular disease in older patients with hip fracture according to serum parathyroid hormone and urinary deoxypyridinoline levels.Notes: High levels were defined as exceeding the upper limits of normal range: >6.8 pmol/L for serum PTH and >7.5 nmol/μmol for urinary DPD/Cr. Adjustment was made for age, sex, smoking status, alcohol consumption, dementia, hip-fracture type, eGFR < 60 mL/minute/1.73 m2, 25(OH)D < 50 nmol/L and albumin < 33 g/L. The odds ratios compared to the reference group (both PTH and DPD/Cr in the normal range) are shown.Abbreviations: PTH, parathyroid hormone; DPD/Cr, deoxypyridinoline corrected by urinary creatinine; 25(OH)D, 25-hydroxyvitamin D; eGFR, estimated glomerular filtration rate.
Mentions: Further, we examined the unique and combined effects of abnormally high PTH and DPD/Cr levels as indicators of presence of CVD (Table 6). Compared to subjects with normal serum PTH and urinary DPD/Cr levels (reference group), the age-and sex-adjusted OR for CVD (model 1) was significantly greater in patients with high DPD/Cr and normal PTH levels (OR 4.26, P = 0.005), but the highest risk of CVD was in patients with elevated PTH and both normal (OR 10.27, P = 0.004) and high DPD/Cr (OR 7.61, P < 0.001). After adjustment for seven additional factors was made, the OR for the presence of CVD further increased (model 2, Table 6): 17.32 in patients only with SHPT, 9.68 in patients with SHPT and high DPD/Cr, and 5.33 in subjects only with excess bone resorption. These associations are displayed in Figure 1. In total, the OR for presence of CVD among HF patients with SHPT or excess bone resorption compared to those with both parameters in the normal range was 7.54 (Table 6).

Bottom Line: Vitamin D deficiency was similarly prevalent in patients with (78.0%) and without (82.1%) CVD.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia. alex.fisher@act.gov.au

ABSTRACT

Background: 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.

Show MeSH
Related in: MedlinePlus