Valvular heart disease
Osteoporosis Treatment and Progression of Aortic Stenosis

https://doi.org/10.1016/j.amjcard.2009.02.051Get rights and content

A decrease in bone mineral density has been reported to be associated with increased progression of aortic stenosis (AS). We hypothesized that osteoporosis treatment (OT) is associated with decreased progression of AS. We performed an observational study of patients with AS from our echocardiographic database comparing 18 patients on OT (bisphosphonates, calcitonin, or estrogen receptor modulators) with 37 patients not on OT. All patients had serial echocardiograms. Patients with mitral stenosis, aortic valve replacement, renal failure, calcium disorders, or left ventricular ejection fraction <40% were excluded. Aortic valve area (AVA) was calculated using the continuity equation. There was no significant difference in age, gender, renal function, hypertension, statin use, diabetes, or calcium level between the 2 groups. Mean baseline AVA was 1.33 cm2 and not significantly different between groups. After a mean of 2.4 ± 1.0 years, mean annual changes in AVA were −0.22 ± 0.22 cm2 in those not on OT and −0.10 ± 0.18 cm2 in patients receiving OT (p = 0.025). There was a graded association between AS progression rate and OT. In a multivariable analysis including age, gender, and statin use, only OT was associated with a change in AVA. In conclusion, OT is strongly and independently associated with decreased progression of AS. This association warrants investigation in a larger, prospective study.

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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

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