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Bisphosphonates and atherosclerosis: why?
M Bevilacqua1, L J Dominguez, S Rosini
1Endocrine and Diabetes Unit, Ospedale L Sacco, Vialba, University of Milan, Italy. mauriziobevilacqua@fastwebnet.it
Insights
Bisphosphonates, used for osteoporosis, may also treat atherosclerosis by inhibiting arterial calcification and lipid accumulation. Further clinical research is needed to confirm these potential dual benefits.
Area of Science:
- Biochemistry
- Cardiovascular Medicine
- Pharmacology
Background:
- Bone calcification processes share similarities with vascular calcification, a contributor to cardiovascular diseases like heart failure and hypertension.
- Bisphosphonates are widely used to treat bone resorption diseases such as osteoporosis by inhibiting osteoclasts.
Purpose of the Study:
- To explore the potential of bisphosphonates in treating atherosclerosis.
- To investigate the mechanisms by which bisphosphonates might inhibit vascular calcification and related cardiovascular issues.
Main Methods:
- Review of existing studies on bisphosphonates' effects on experimental atherosclerosis.
- Analysis of proposed mechanisms including inhibition of arterial calcification, lipid accumulation, LDL-cholesterol degradation, and macrophage suppression.
Main Results:
- Specific bisphosphonates (etidronate, pamidronate, clodronate) have shown inhibition of experimental atherosclerosis.
- Proposed mechanisms involve inhibiting cholesterol biosynthesis enzymes and suppressing macrophages in atheromatous lesions.
Conclusions:
- Bisphosphonates demonstrate potential for treating both osteoporosis and atherosclerosis.
- Current evidence is not conclusive, and further clinical research is necessary to validate these findings.
Abstract:
The increasing knowledge on bone calcification processes has revealed some similarities with vascular tissue, where calcifications of arteries and cardiac valves contribute to several cardiovascular problems, such as heart failure, systolic hypertension, and myocardial and peripheral ischemic disease. Bisphosphonates have been used extensively for over two decades for the treatment of diseases associated with excessive bone resorption, i.e., osteoporosis, osteolytic bone metastasis, hypercalcemia and Paget's disease, by blocking osteoclastic function. Etidronate, pamidronate and clodronate has been shown to inhibit the development of experimental atherosclerosis, and proposed mechanisms for this action include inhibition of arterial calcification and lipid accumulation, degradation of atherogenic LDL-cholesterol and reduced foam cell formation. Bisphosphonates inhibit various enzymes involved in cholesterol biosynthesis and suppress macrophages in atheromatous lesions. The possibility of pharmacological agents that effectively treat both osteoporosis and atherosclerosis is attractive, however, current evidence is not conclusive and further research is necessary to confirm these actions in the clinical setting.
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