Background/Purpose:

Although traditionally viewed as separate disease entities that increase in prevalence with aging, accumulating evidence indicates that similar pathophysiological mechanisms may underlie cardiovascular disease and osteoporosis. Endothelial dysfunction is the initial step in the atherosclerotic process. The aims of this study were to determine if women with post-menopausal osteoporosis have impaired endothelial function.

Methods:

We used non-invasive Doppler ultrasound to assess endothelial function in sixty women with post-menopausal osteoporosis and compared results to 30 age, sex matched controls. After measurement of traditional cardiovascular risk factors, we measured flow mediated dilation (FMD) of the brachial artery in subjects. Flow mediated dilation is a dynamic assessment of endothelium-dependent and -independent dilation of an artery. Subjects were further assessed using radial artery tonometry. Isoprostane levels, which are a marker of oxidative stress, were compared between groups.

Results:

Groups were equally matched for age, weight, blood pressure, cholesterol profile and smoking history. Results from radial artery tonometry indicated that cardiac output (p=0.03), large artery elasticity index (p=0.03) and small artery elasticity index (p=0.03) readings were significantly higher in the healthy control group. Systemic vascular resistance (p=0.005) and total vascular impedance (p=0.032) was statistically significantly higher in patients with osteoporosis compared to controls. Flow mediated dilatation of the brachial artery showed a statistically significant better dilatation of the brachial artery post cuff deflation in healthy controls (p=0.006), although there was no difference in endothelium-independent dilation ie. brachial artery dilation after administration of GTN. Isoprostane levels were statistically significantly higher in the osteoporosis group

Conclusion:

The differences in flow mediated dilatation between healthy controls and post-menopausal women with osteoporosis may indicate impaired endothelial function and reflect the local distensibility of the brachial artery or the distal microcirculation’s response to the ischaemic stimulus. Radial artery tonometry results also support a difference in endothelial function between groups. Changes in vascular reactivity are likely to be multi-factorial but may be related in part to differences in levels of oxidative stress between groups. This study demonstrates that further work is required on the assessment of potential structural remodelling in small arteries and vascular beds that may precede clinically detectable cardiovascular disease in women with post-menopausal osteoporosis. Further work is also required on the complex interaction of common risk factors and genetic or molecular determinants of both conditions.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impaired-endothelial-function-in-post-menopausal-women-with-osteoporosis/