Common mechanisms and holistic care in atherosclerosis and osteoporosis

Abstract

Cardiovascular (CV) disease and osteoporosis (OP) have become increasing challenges in the aging population and even more in patients with inflammatory rheumatic diseases, such as rheumatoid arthritis, spondyloarthropathies, and systemic lupus erythematosus. In this review, we discuss how the epidemiology and pathogenesis of CV events and OP are overlapping. Smoking, diabetes mellitus, physical inactivity as conventional risk factors as well as systemic inflammation are among the modifiable risk factors for both CV events and bone loss. In rheumatic patients, systemic "high-grade" inflammation may be the primary driver of accelerated atherogenesis and bone resorption. In the general population, in which some individuals might have low-grade systemic inflammation, a holistic approach to drug treatment and lifestyle modifications may have beneficial effects on the bone as well as the vasculature. In rheumatic patients with accelerated inflammatory atherosclerosis and bone loss, the rapid and effective suppression of inflammation in a treat-to-target regime, aiming at clinical remission, is necessary to effectively control comorbidities.

Keywords: Atherosclerosis; Bone loss; DXA; Inflammation; Osteoporosis; Rheumatoid arthritis; Risk factors.

Fig. 1

The “Bermuda triangle” of atherosclerosis, osteoporosis, and inflammation. Under non-inflammatory states, common conventional risk factors and “low-grade” inflammation may link atherogenesis and bone loss. In case of an underlying inflammatory disease, such as rheumatoid arthritis, “high-grade” systemic inflammation may perpetuate the development of atherosclerosis and osteoporosis