title: Coronary microvascular endothelial dysfunction is an independent predictor of development of osteoporosis in postmenopausal women.
abstract: BACKGROUND
  A growing body of evidence links coronary artery atherosclerosis and calcification to osteoporosis in women. The endothelium plays a critical role in maintaining vascular integrity and may play a role in bone metabolism. We aimed to determine whether early coronary atherosclerosis, as detected by coronary microvascular endothelial dysfunction (CMED), predicts the development of osteoporosis in postmenopausal women.
  
  
  METHODS
  Coronary vascular reactivity was evaluated in 194 postmenopausal women greater than 50 years of age and with non-obstructive coronary arteries by administration of intracoronary acetylcholine during diagnostic angiography. CMED was defined as ≤50% increase in coronary blood flow from baseline in response to maximal dose. After a median follow-up of 7.0±0.3 years, patients were assessed by a questionnaire for development of osteoporosis.
  
  
  RESULTS
  The average age of the cohort was 60.9±7.4 years. Women with CMED were twice as likely to develop osteoporosis compared with women without endothelial dysfunction after adjustment for potential confounders (relative risk, 2.4; 95% confidence interval [CI], 1.1, 5.6, P=0.02). Epicardial endothelial dysfunction was not associated with development of osteoporosis.
  
  
  CONCLUSIONS
  Early coronary atherosclerosis with endothelial dysfunction is an independent marker for increased risk of developing osteoporosis in postmenopausal women greater than 50 years of age without obstructive coronary artery disease. The current study supports a link between coronary atherosclerosis and osteoporosis.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Megha
authors.initials: M
authors.lastname: Prasad
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Reriani
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sundeep
authors.initials: S
authors.lastname: Khosla
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Gössl
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Lennon
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gulati
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Abhiram
authors.initials: A
authors.lastname: Prasad
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Lilach O
authors.initials: LO
authors.lastname: Lerman
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
mesh_terms: D000109:Acetylcholine; D000367:Age Factors; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D008910:Minnesota; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D017698:Postmenopause; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014664:Vasodilation; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D000109:Acetylcholine
keywords: coronary artery disease; endothelial dysfunction; endothelial progenitor cells; low bone mass; screening