Abstract
Beyond being aging-related diseases, atherosclerosis and osteoporosis share common pathogenetic pathways implicated in bone and vascular mineralization. However, the contributory role of dyslipidemia in this interplay is less documented. The purpose of this narrative review is to provide epidemiological evidence regarding the prevalence of bone disease (osteoporosis, fracture risk) in patients with dyslipidemias and to discuss potential common pathophysiological mechanisms linking osteoporosis and atherosclerosis. The effect of hypolipidemic therapy on bone metabolism is also discussed. Despite the high data heterogeneity and the variable quality of studies, dyslipidemia, mainly elevated total and low-density lipoprotein cholesterol concentrations, is associated with low bone mass and increased fracture risk. This effect may be mediated directly by the increased oxidative stress and systemic inflammation associated with dyslipidemia, leading to increased osteoclastic activity and reduced bone formation. Moreover, factors such as estrogen, vitamin D and K deficiency, and increased concentrations of parathyroid hormone, homocysteine and lipid oxidation products, can also contribute. Regarding the effect of hypolipidemic medications on bone metabolism, statins may slightly increase BMD and reduce fracture risk, although the evidence is not robust, as it is for omega-3 fatty acids. No evidence exists for the effects of ezetimibe, fibrates, and niacin. In any case, more prospective studies are needed further to elucidate the association between lipids and bone strength.
Highlights
Beyond being aging-related diseases, atherosclerosis and osteoporosis share common pathogenetic pathways implicated in bone and vascular mineralization
high-density lipoprotein cholesterol (HDL-C) and total cholesterol (TC) concentrations were higher in the osteoporosis compared with the normal bone mineral density (BMD) group [HDL-C: mean difference (MD) 2.63, 95% confidence interval (CI) 0.43–4.84; TC: MD 14.82, 95% CI 2.84–26.80]
Concerning HDL-C, there was no association with fractures, subgroup analysis from prospective studies showed an 18% lower risk of fractures in those with HDL-C < 40 mg/dL compared with individuals with HDL-C > 40 mg/dL
Summary
Epidemiological data regarding the association between lipid profile and bone mineral density (BMD) are inconsistent. Another study investigated the association between lipid profile and BMD in two different cohorts, one from the general population (n = 265 males, 481 females) and one from patients attending an osteoporosis clinic (n = 236 pre- and postmenopausal women) [7] In both groups, TH BMD was positively associated with LDL-C (p < 0.05) and TG (p < 0.05) and negatively with HDL-C concentrations (p < 0.05) in both genders, even after adjustment for body weight, height, and fat mass. After correction for potential confounders, such as age, sex, body mass index (BMI), and statin use, the association between lipid profile and BMD lost significance [11] Another cross-sectional study (n = 1303 postmenopausal women who attended a menopause clinic) showed a higher prevalence of low LS BMD in those with high LDL-C concentrations (>160 mg/dL) compared with those with LDL-C
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