Notarnicola A, Maccagnano G, Moretti L, Tafuri S, Moretti B
Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Bari, Italy.
Department of Biomedical Sciences and Human Oncology, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Bari, Italy.
J Biol Regul Homeost Agents. 2017 Jan-Mar;31(1):251-255.
Cardiopathies and osteoporosis are inter-related due to pathogenetic, hormonal, genetic features as well as an increased risk of fragility. An important feature is attributed to the process of atherosclerosis, which is responsible for an osteopenia effect and degeneration of vascular walls. To date the study populations have been limited. To verify the incidence of cardio-vascular disease in a larger osteoporotic population, we designed a retrospective clinical study analyzing the Hospital Discharge Data (HDD) in Apulia between 2006 and 2010. All patients over 55 years with a hospitalization for a fragility fracture and/or drugs prescription for osteoporosis were crossed with the diagnosis and/or drugs prescription for cardiovascular disease. We observed that between 2006 and 2010, in Apulia, 177,639 patients were hospitalized and diagnosed as having fragility fractures, 66.3% had a diagnosis of cardiopathy, with a higher prevalence in males and in patients over 80 years. The incidence of fractures were as follows: femur (51.9%), spine (20.2%), humerus (10.6%), forearm (9%), tibial pilon (7.2%) and tarsus and metatarsus (1.1%). Cerebrovascular diseases were the most frequent, followed by arrhythmias, heart failure and cardiomyopathies. In these patients, the most prescribed drugs were anti-coagulants, ACE inhibitors and diuretics. In patients affected by cerebral circulation disorder there is a greater propensity to fall and thus have a fragility fracture, particularly of the femur. The vertebral fracture, misdiagnosed in 60-70% of patients, may compromise the cardio-respiratory function of these patients. We verified a higher incidence of fragility fractures in patients who were prescribed certain categories of drugs for the treatment of cardio-vascular disease. This hypothesis is not supported by the literature, where contradictory results on the potential effects of these drugs on bone have been published. The high incidence of heart disease found in patients with fragility fractures supports the need for specific screening for osteoporosis in the population with cardio-circulatory pathology.
由于发病机制、激素、遗传特征以及骨折风险增加，心脏病和骨质疏松症相互关联。动脉粥样硬化过程具有重要特征，它会导致骨质减少和血管壁退化。迄今为止，研究人群有限。为了核实更大规模骨质疏松症人群中心血管疾病的发病率，我们设计了一项回顾性临床研究，分析2006年至2010年普利亚大区的“医院出院数据”（HDD）。所有55岁以上因脆性骨折住院和/或开具骨质疏松症药物处方的患者，都与心血管疾病的诊断和/或药物处方进行了交叉比对。我们观察到，2006年至2010年期间，在普利亚大区，177,639名患者因脆性骨折住院并被诊断患有该病，其中66.3%被诊断患有心脏病，男性和80岁以上患者的患病率更高。骨折发生率如下：股骨（51.9%）、脊柱（20.2%）、肱骨（10.6%）、前臂（9%）、胫腓骨远端（7.2%）以及跗骨和跖骨（1.1%）。脑血管疾病最为常见，其次是心律失常、心力衰竭和心肌病。在这些患者中，最常开具的药物是抗凝剂、血管紧张素转换酶抑制剂和利尿剂。患有脑循环障碍的患者更容易跌倒，进而发生脆性骨折，尤其是股骨骨折。60%至70%的患者的椎体骨折被误诊，这可能会损害这些患者的心肺功能。我们证实，开具某些治疗心血管疾病药物的患者中脆性骨折的发生率更高。这一假设未得到文献支持，文献中已发表了关于这些药物对骨骼潜在影响的相互矛盾的结果。脆性骨折患者中心脏病的高发病率表明，对于患有心血管疾病的人群，有必要进行骨质疏松症的专项筛查。
