Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/EPM), São Paulo, Brazil.
Bone. 2013 Feb;52(2):562-7. doi: 10.1016/j.bone.2012.11.004. Epub 2012 Nov 9.
Cardiovascular disease and osteoporosis are important causes of morbi-mortality in the elderly and may be mutually related. Low bone mineral density (BMD) may be associated with increased risk of cardiovascular events. We investigated the prevalence of low bone mass and fractures in metabolic syndrome patients with acute coronary events. A case-control study was conducted with 150 individuals (30-80years-old) with metabolic syndrome. Seventy-one patients had had an acute coronary syndrome episode in the last 6months (cases) and the remaining 79 had no coronary event (controls). Cases and controls were matched for gender, BMI and age. DXA measurements and body composition were performed while spine radiographs surveyed for vertebral fractures and vascular calcification. Biochemical bone and metabolic parameters were measured in all patients. No statistically significant difference in BMD and the prevalence of osteopenia, osteoporosis and non-vertebral fractures was observed between cases and controls. The prevalence of vertebral fractures and all fractures was higher in the cases (14.1 versus 1.3%, p=0.003 and 22.5versus7.6%, p=0.010, respectively). Male gender (OR=0.22 95% CI 0.58 to 0.83, p=0.026) and daily intake of more than 3 portions of dairy products (OR=0.19 95% CI 0.49 to 0.75, p=0.017) were associated with lower prevalence of fractures. Cases had higher risk for fractures (OR=4.97, 95% CI 1.17 to 30.30, p=0.031). Bone mass and body composition parameters were not associated with cardiovascular risk factors or bone mineral metabolism. Patients with fragility fractures had higher OPG serum levels than those without fractures (p<0.001). Our findings demonstrated that patients with recent coronary events have a higher prevalence of vertebral fractures independently of BMD.
心血管疾病和骨质疏松症是老年人发病率和死亡率的重要原因，两者可能相互关联。低骨密度（BMD）可能与心血管事件风险增加有关。我们研究了代谢综合征合并急性冠脉事件患者中低骨量和骨折的患病率。这是一项病例对照研究，共纳入了 150 名（30-80 岁）代谢综合征患者。71 名患者在过去 6 个月内发生过急性冠脉综合征（病例组），其余 79 名患者无冠脉事件（对照组）。病例组和对照组在性别、BMI 和年龄方面相匹配。所有患者均进行 DXA 测量和身体成分检查，同时拍摄脊柱 X 光片以检测椎体骨折和血管钙化。测量了所有患者的生化骨和代谢参数。病例组和对照组之间的 BMD 及骨量减少、骨质疏松和非椎体骨折的患病率无统计学差异。病例组的椎体骨折和所有骨折的患病率均较高（14.1%比 1.3%，p=0.003；22.5%比 7.6%，p=0.010）。男性（OR=0.22，95%CI 0.58 至 0.83，p=0.026）和每日摄入乳制品超过 3 份（OR=0.19，95%CI 0.49 至 0.75，p=0.017）与骨折的低患病率相关。病例组骨折的风险更高（OR=4.97，95%CI 1.17 至 30.30，p=0.031）。骨量和身体成分参数与心血管危险因素或骨矿物质代谢无关。脆性骨折患者的 OPG 血清水平高于无骨折患者（p<0.001）。我们的研究结果表明，近期发生冠脉事件的患者无论 BMD 如何，椎体骨折的患病率均较高。
