title: Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links.
abstract: BACKGROUND
  Considerable controversy exists regarding the contribution of mineral/bone metabolism abnormalities to the association between cardiovascular diseases (CVDs) and osteoporotic fractures.
  
  
  OBJECTIVE
  To determine the relationships between mineral/bone metabolism biomarkers and CVD in 746 older patients with hip fracture, clinical data were recorded and serum concentrations of parathyroid hormone (PTH), 25-hydroxyvitamin D, calcium, phosphate, magnesium, troponin I, parameters of bone turnover, and renal, liver, and thyroid functions were measured.
  
  
  RESULTS
  CVDs were diagnosed in 472 (63.3%) patients. Vitamin D deficiency was similarly prevalent in patients with (78.0%) and without (82.1%) CVD. The CVD group had significantly higher mean PTH concentrations (7.6 vs 6.0 pmol/L, P < 0.001), a higher prevalence of secondary hyperparathyroidism (SPTH) (PTH > 6.8 pmol/L, 43.0% vs 23.3%, P < 0.001), and excess bone resorption (urinary deoxypyridinoline corrected by creatinine [DPD/Cr] > 7.5 nmol/μmol, 87.9% vs 74.8%, P < 0.001). In multivariate regression analysis, SHPT (odds ratio [OR] 2.6, P = 0.007) and high DPD/Cr (OR 2.8, P = 0.016) were independent indictors of CVD. Compared to those with both PTH and DPD/Cr in the normal range, multivariate-adjusted ORs for the presence of CVD were 17.3 (P = 0.004) in subjects with SHPT and 9.7 (P < 0.001) in patients with high DPD/Cr. CVD was an independent predicator of SHPT (OR 2.8, P = 0.007) and excess DPD/Cr (OR 2.5, P = 0.031). CVD was predictive of postoperative myocardial injury, while SHPT was also an independent predictor of prolonged hospital stay and in-hospital death.
  
  
  CONCLUSIONS
  SHPT and excess bone resorption are independent pathophysiological mediators underlying the bidirectional associations between CVD and hip fracture, and therefore are important diagnostic and therapeutic targets.
authors: Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia. alex.fisher@act.gov.au
authors: A
authors: A
authors: Fisher
authors: W
authors: W
authors: Srikusalanukul
authors: M
authors: M
authors: Davis
authors: P
authors: P
authors: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D001842:Bone and Bones / Q000378:metabolism; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D015897:Comorbidity; D004365:Drugs, Chinese Herbal; D028001:Eleutherococcus; D015438:Health Behavior; D006620:Hip Fractures / Q000097:blood / Q000453:epidemiology*; D006801:Humans; D008903:Minerals / Q000378:metabolism; D058866:Osteoporotic Fractures / Q000097:blood / Q000453:epidemiology*; D010281:Parathyroid Hormone / Q000097:blood; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D004365:Drugs, Chinese Herbal; D008903:Minerals; D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D; C400150:Acanthopanax gracilistylus, extract
keywords: 25(OH)D; PTH; bone turnover; cardiovascular disease; hip fracture; mineral metabolism; secondary hyperparathyroidism