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Common mechanisms and holistic care in atherosclerosis and osteoporosis
Zoltán Szekanecz1, Hennie G Raterman2, Zsófia Pethő3
1Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei street 98, Debrecen, 4032, Hungary. szekanecz.zoltan@med.unideb.hu.
Insights
Cardiovascular disease and osteoporosis share overlapping risk factors, including systemic inflammation, particularly in patients with rheumatic diseases. Effective inflammation control is crucial for managing these intertwined conditions.
Area of Science:
- Rheumatology
- Cardiology
- Endocrinology
- Gerontology
Background:
- Cardiovascular (CV) disease and osteoporosis (OP) pose significant challenges, especially in aging populations and individuals with inflammatory rheumatic diseases like rheumatoid arthritis, spondyloarthropathies, and systemic lupus erythematosus.
- Both CV events and OP share common epidemiological and pathogenetic pathways.
- Modifiable risk factors such as smoking, diabetes mellitus, physical inactivity, and systemic inflammation contribute to both CV disease and bone loss.
Purpose of the Study:
- To review the overlapping epidemiology and pathogenesis of cardiovascular events and osteoporosis.
- To highlight the role of systemic inflammation as a primary driver in rheumatic patients.
- To discuss holistic approaches for managing these comorbidities in both general and rheumatic patient populations.
Main Methods:
- This is a review article, synthesizing existing literature on cardiovascular disease and osteoporosis.
- The review examines epidemiological data and pathogenetic mechanisms linking CV events and OP.
- It discusses the impact of systemic inflammation and conventional risk factors.
Main Results:
- Systemic inflammation, especially 'high-grade' inflammation in rheumatic diseases, accelerates atherogenesis and bone resorption.
- In the general population, low-grade inflammation also contributes to CV events and bone loss.
- Conventional risk factors like smoking, diabetes, and inactivity are common to both conditions.
Conclusions:
- A holistic approach combining drug treatment and lifestyle modifications can benefit bone and vasculature in the general population.
- In rheumatic patients, rapid and effective suppression of inflammation via treat-to-target strategies is essential for managing accelerated atherosclerosis and bone loss.
- Controlling inflammation is key to effectively managing comorbidities in patients with inflammatory rheumatic diseases.
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.
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