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Both cardiovascular diseases and osteoporosis are related to an enormous economic burden and increased risk of morbidity and mortality. In the last years an intensive interplay between the bone and vasculature the bone-vascular axis and the cooccurrence of cardiovascular and bone diseases in various populations have been increasingly documented. The interdependence of heart and vascular physiology, skeletogenesis and bone mineralization is translated into clinically relevant associations between cardiovascular diseases and osteoporosis irrespective of kidney function or vascular calcification. Observational studies confirmed an independent relationship between bone loss, osteoporotic fractures and atherosclerotic diseases.br In a systematic literature search (Medline, Pubmed) we identified 49 prospective observational studies which investigated the association between cardiovascular diseases, osteoporosis, bone mineral density and fracture risk. A great majority of these longitudinal analyses, which were however characterized by large heterogeneity in study population, duration of follow-up and considerations of potential confounders, revealed an increased risk of cardiovascular morbidity and mortality in women and men with low bone mineral density at different locations as well as in those with previous osteoporotic fractures. In addition, several studies noted a higher risk for the development of osteoporosis and osteoporotic fractures in patients with cardiovascular diseases. In particular, consistent associations were found between heart failure (7 studies), stroke (16 studies), peripheral arterial disease (3 studies) and both osteoporosis and fracture risk, respectively.br Observational studies provided in this systemic review are limited in several fields similar to previous analyses, which identified currently accepted risk factors for osteoporosis and subsequent fracture risk. In view of the burden associated with cardiovascular and bone diseases the current evidence however indicates a potential benefit in screening for cardiovascular diseases and osteoporosis in respective risk groups. p bKurzfassung/b: Osteoporose und atherosklerotische Erkrankungen sind mit massiv erhöhter Morbidität, Mortalität und Gesundheitskosten verbunden. Mit der bone-vascular axis entstand in den letzten Jahren ein intensiv beforschtes, klinisch hoch relevantes Gebiet. Mechanistische Studien identifizierten komplexe wechselseitige Beziehungen zwischen der vaskulären Physiologie, der Knochenneubildung und der Knochenmineralisation. Herz und Gefäße spielen eine relevante Rolle für die muskuloskelettale Funktion und umgekehrt beeinflusst das Knochengewebe u. a. über endo- und parakrine Signalwege das Herz-Kreislaufsystem. Epidemiologische Studien wiesen auch nach Berücksichtigung gemeinsamer Risikofaktoren auf unabhängige, wechselseitige Interaktionen zwischen Herz, Gefäßen und Knochengewebe hin.brIm Rahmen einer systematischen Literaturrecherche (Medline, Pubmed) wurden insgesamt 49 prospektive Studien, die den Zusammenhang zwischen Osteoporose, Knochenmineraldichte und Auftreten von Frakturen mit atherosklerotischen Erkrankungen beschreiben, selektiert. Dabei konnten diese Untersuchungen mehrheitlich eine erhöhte kardiovaskuläre Morbidität und Mortalität bei Frauen und Männern mit verminderter Knochenmineraldichte an verschiedenen Lokalisationen sowie nach osteoporotischen Frakturen nachweisen. Umgekehrt konnten zahlreiche Studien ein erhöhtes Risiko für die Entstehung einer Osteoporose sowie von osteoporotischen Frakturen bei Patienten mit atherosklerotischen Erkrankungen nachweisen. Schließlich konnten konsistente Assoziationen zwischen Herzinsuffizienz (7 Studien), Schlaganfall (16 Studien), peripherer arterieller Verschlusskrankheit (3 Studien) und Knochenmineraldichte sowie Frakturrisiko detektiert werden.brGrundsätzlich lassen Beobachtungsstudien keine Rückschlüsse auf die Kausalität der Assoziationen zu. Mehrere weitere Limitierungen der Studien führen zu einer insgesamt eingeschränkten Aussagekraft der publizierten Ergebnisse. Diese Einschränkungen gelten jedoch auch für Studien, welche die aktuell etablierten Risikofaktoren identifizierten. Die Prävention sowie Früherkennung sowohl von kardiovaskulären als auch osteologischen Erkrankungen sind von eminenter Bedeutung. Die vorliegende Datenlage spricht sowohl für ein kardiovaskuläres Screening von Patienten mit Osteoporose oder osteoporotischen Frakturen als auch für eine osteologische Untersuchung von Patienten mit fortgeschrittenen atherosklerotischen Erkrankungen.

Background: Accumulating evidence points toward mutual interaction between parathyroid hormone (PTH) and aldosterone as potential mechanism for increasing cardiovascular risk in primary hyperparathyroidism (pHPT). Methods: The Eplerenone on parathyroid hormone levels in patients with primary hyperparathyroidism (EPATH) trial is a single-center, randomized, double-blind, parallel-group, placebo-controlled trial. The primary aim is to evaluate the effects of the mineralocorticoid receptor antagonist eplerenone on plasma intact PTH (iPTH) concentration in patients with pHPT. Secondary end points comprised surrogate parameters of cardiovascular health [ 24-h ambulatory SBP and DBP and echocardiographic parameters related to systolic/diastolic function as well as to cardiac dimensions]. Results: We enrolled 110 study participants with pHPT, 25-hydroxyvitamin D at least 20 ng/ml and estimated glomerular filtration rate more than 50 ml/min per 1.73 m(2). Patients were 1 : 1 randomly assigned to receive either 25mg eplerenone once daily (up-titration after 4 weeks to 50 mg/day) or matching placebo for a treatment period of 8 weeks. The study was completed by 97 participants [ mean (SD) age: 67.5 +/- 9.5 years; 78.4% women). The mean treatment effect (95% confidence interval) for iPTH was 1.0 (0.9-1.1; P = 0.777) pg/ml. Mean 24-h ambulatory SBP and DBP decreased significantly [ mean change (95% confidence interval) -6.3 (-9.4 to -3.3) and -3.7 (-5.7 to -1.7) mmHg, respectively; P

Both cardiovascular diseases and osteoporosis are related to an enormous economic burden and increased risk of morbidity and mortality. In the last years an intensive interplay between the bone and vasculature - the bone-vascular axis - and the co-occurrence of cardiovascular and bone diseases in various populations have been increasingly documented. The interdependence of heart and vascular physiology, skeletogenesis and bone mineralization is translated into clinically relevant associations between cardiovascular diseases and osteoporosis irrespective of kidney function or vascular calcification. Observational studies confirmed an independent relationship between bone loss, osteoporotic fractures and atherosclerotic diseases. In a systematic literature search (Medline, Pubmed) we identified 49 prospective observational studies which investigated the association between cardiovascular diseases, osteoporosis, bone mineral density and fracture risk. A great majority of these longitudinal analyses, which were however characterized by large heterogeneity in study population, duration of follow-up and considerations of potential confounders, revealed an increased risk of cardiovascular morbidity and mortality in women and men with low bone mineral density at different locations as well as in those with previous osteoporotic fractures. In addition, several studies noted a higher risk for the development of osteoporosis and osteoporotic fractures in patients with cardiovascular diseases. In particular, consistent associations were found between heart failure (7 studies), stroke (16 studies), peripheral arterial disease (3 studies) and both osteoporosis and fracture risk, respectively. Observational studies provided in this systemic review are limited in several fields similar to previous analyses, which identified currently accepted risk factors for osteoporosis and subsequent fracture risk. In view of the burden associated with cardiovascular and bone diseases the current evidence however indicates a potential benefit in screening for cardiovascular diseases and osteoporosis in respective risk groups.