title: Increased Bone Resorption: A Possible Pathophysiological Link Between Hypovitaminosis D and Peripheral Arterial Disease.
abstract: Vitamin D deficiency has been associated with the prevalence and severity of peripheral arterial disease (PAD); nevertheless, data on bone turnover in patients with PAD is lacking. The present study investigates a possible relationship between the markers of bone turnover and the presence and severity of PAD.
  
  
  
  The study examined 143 patients, with a mean ± SD age of 75.3 ± 8.5 years (range 50.0-93.0 years), of both sexes, admitted to a department of internal medicine. All patients underwent ankle brachial index (ABI) assessment by Doppler velocimetry. Serum levels of 25(OH) vitamin D and two markers of bone turnover, C-terminal telopeptide of type I collagen (sCTX) and bone isoenzyme of alkaline phosphatase, were measured. The differences between patients with normal ABI and patients with PAD were analyzed. Pearson and Spearman correlation coefficients were calculated and independent predictors were identified through a stepwise linear regression analysis. Odds ratios were calculated with a logistic regression model.
  
  
  
  Compared with patients with a normal ABI (≥0.90), patients with PAD (ABI < 0.90) presented with significantly lower levels of 25(OH) vitamin D (12.2 ± 9.6 ng/mL vs. 16.7 ± 8.7 ng/mL; p = .006) and a significantly higher concentration of sCTX (1.1 ± 0.7 ng/mL vs. 0.6 ± 0.4 ng/mL; p < .001). There was a positive correlation between ABI and serum concentration of 25 (OH) vitamin D (r = 0.3; p < .001), whereas ABI was inversely correlated with the concentration of sCTX (r = -0.358; p < .001). At logistic regression analysis, age, cigarette smoking, and both vitamin D and sCTX were independent predictors of an ABI < 0.90.
  
  
  
  These results support the hypothesis that hypovitaminosis D and increased bone turnover are risk factors for the presence and severity of PAD. Furthermore, the presence of PAD, even if asymptomatic and diagnosed by a reduced ABI, could identify a population at risk for osteoporosis and osteomalacia.
authors.affiliation: Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy. Electronic address: leonella.pasqualini@unipg.it.
authors.forename: L
authors.initials: L
authors.lastname: Pasqualini
authors.affiliation: Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Ministrini
authors.affiliation: Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Macura
authors.affiliation: Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Marini
authors.affiliation: Department of Experimental Medicine, Division of Microbiology, University of Perugia, Perugia, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Leli
authors.affiliation: Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Siepi
authors.affiliation: Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Lombardini
authors.affiliation: Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy.
authors.forename: M N
authors.initials: MN
authors.lastname: Kararoudi
authors.affiliation: Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy.
authors.forename: A M
authors.initials: AM
authors.lastname: Scarponi
authors.affiliation: Department of Medicine, Division of Internal Medicine, University of Perugia, Terni, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Schillaci
authors.affiliation: Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Pirro
authors.affiliation: Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Mannarino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D055109:Ankle Brachial Index; D015415:Biomarkers / Q000097:blood; D001862:Bone Resorption / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016009:Chi-Square Distribution; D024042:Collagen Type I / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010455:Peptides / Q000097:blood; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D012307:Risk Factors; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D024042:Collagen Type I; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D000469:Alkaline Phosphatase
keywords: Ankle brachial index; Bone resorption; C-terminal telopeptide of type I collagen; Peripheral arterial disease; Vitamin D deficiency