Valvular heart diseaseOsteoporosis Treatment and Progression of Aortic Stenosis
Section snippets
Methods
We retrospectively screened consecutive inpatient echocardiograms in the New York University (New York, New York) echocardiographic database demonstrating AS with a peak aortic valve gradient <64 mm Hg. All patients had to have an echocardiogram performed from 2002 through 2004 with a follow-up echocardiogram ≥1 year after the index echocardiogram. All echocardiograms were reviewed off-line by an expert echocardiographer blinded for treatment status and date of examination. Left ventricular
Results
At the time of the index echocardiogram 18 patients received osteoporosis treatment (OT+; 12 on bisphosphonates, 4 on calcitonin, and 2 on selective estrogen receptor modulators) and 37 patients did not (OT−). Patients were predominantly elderly, women, and Caucasian, with no significant difference between the 2 groups. Mean serum creatinine was 1.1 mg/dl. Rates of hypertension, diabetes, and coronary artery disease were not significantly different. All OT+ patients were diagnosed with
Discussion
Our results suggest that there is an association between use of osteoporosis medications and decreased progression of AS in humans. The mechanism by which treating osteoporosis decreases vascular and valvular calcifications is complex and incompletely understood. It is, however, known that osteoporosis and AS have much in common. Both conditions are associated with increasing chronologic age, estrogen deficiency, dyslipidemia, chronic inflammation, and abnormalities of vitamin D homeostasis.11
References (15)
- et al.
Association of Paget's disease of bone with calcific aortic valve disease
Am J Med
(1987) - et al.
Relation of calcium-phosphorus product to the severity of aortic stenosis in patients with normal renal function
Am J Cardiol
(2004) - et al.
Prevention of aortic calcification by etidronate in the renal failure rat model
Eur J Pharmacol
(2007) - et al.
Teriparatide inhibits osteogenic vascular calcification in diabetic low density lipoprotein receptor-deficient mice
J Biol Chem
(2003) - et al.
Osteopontin negatively regulates parathyroid hormone receptor signaling in osteoblasts
J Biol Chem
(2008) - et al.
Osteopontin inhibits mineral deposition and promotes regression of ectopic calcification
Am J Pathol
(2002) - et al.
Aortic valve calcification: association with bone mineral density and cardiovascular risk factors
Coron Artery Dis
(2005)
Cited by (56)
Drugs for Prevention and Treatment of Aortic Stenosis: How Close Are We?
2021, Canadian Journal of CardiologyCitation Excerpt :The oral use of bisphosphonates as a potential option for prevention of AS is supported by data from MESA (Multi-Ethnic Study of Atherosclerosis) which demonstrated that among women over the age of 65 years, bisphosphonates were associated with decreased prevalence of cardiovascular calcification.111 In smaller observational studies, echocardiographic progression of AS was blunted by bisphosphonate use over about 1 to 3 years.112-114 Despite these findings, a large retrospective study in women with mild to moderate AS did not find that bisphosphonates affected the rate of change of valve area, gradients, freedom from aortic valve replacement, or survival over a mean follow-up of about 5 years.115
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in aortic stenosis - Is this the light at the end of the tunnel for patients with aortic stenosis?
2021, Indian Heart JournalCitation Excerpt :Niacin, antisense-specific Lp(a) inhibitors and recombinant apolipoprotein A-1 Milano, an anti-inflammatory molecule that reverses cholesterol transport are also promising alternatives.25 Use of bisphosphonates, calcitonin, and estrogen receptor modulators for the treatment of osteoporosis has also shown a strong and independent association with decreased progression of AS.26 Furthermore, therapies like Tadalafil, Ataciguat, vitamin K2 and Phytine are currently being evaluated for their efficacy on long term benefits in AS patients.25,27
Pathophysiology of Aortic Stenosis and Future Perspectives for Medical Therapy
2020, Cardiology ClinicsCitation Excerpt :Bisphosphonates, widely used in the management of osteoporosis, are analogues of endogenous inorganic pyrophosphate, an important regulator of extracellular calcification that inhibits hydroxyapatite formation in cardiovascular tissue.120 Observational studies have suggested that bisphosphonate use is associated with less cardiovascular calcification and slower progression of AS121–124; however conflicting results have been reported.125,126 Another potential therapy in this context is denosumab, a monocloncal antibody against RANKL.
Development of calcific aortic valve disease: Do we know enough for new clinical trials?
2019, Journal of Molecular and Cellular CardiologyCalcification in aortic stenosis: The skeleton key
2015, Journal of the American College of Cardiology