Original Article Gynecol Obstet Invest 2014;78:124–129 DOI: 10.1159/000363746
Received: August 29, 2013 Accepted after revision: May 18, 2014 Published online: July 11, 2014
Renal Function Is Associated with Bone Mineral Density and Arterial Stiffness in Healthy Postmenopausal Women Yeon Soo Jung a, c, e Hee-jin Hwang b Bo Hyon Yun c, e Seung Joo Chon c, e SiHyun Cho d, e Young Sik Choi c, e Young Tae Kim c, e Byung Seok Lee d, e Seok Kyo Seo c, e a
Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital Goyang, and Department of Family Medicine, Kwandong University College of Medicine, Goyang, and c Department of Obstetrics and Gynecology, Severance Hospital, and d Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, and e Institute of Woman’s Life Medical Science, Seoul, Korea b
Key Words Renal function · Bone mineral density · Arterial stiffness · Postmenopausal women
Abstract Background/Aims: This study aimed to investigate the effect of renal function on bone mineral density (BMD) and arterial stiffness in postmenopausal women. Methods: This is a retrospective cross-sectional study. We studied 252 postmenopausal women who visited a health promotion center for a medical checkup. The estimated glomerular filtration rate (eGFR) was calculated using the Cockcroft-Gault (CG) formula and the modification of diet in renal disease (MDRD) formula. Areal BMD measurements were performed using dual-energy X-ray absorptiometry, and arterial stiffness was measured using the brachial-ankle pulse wave velocity (baPWV). Results: The eGFR according to the CG formula was significantly correlated with age, BMI, follicle-stimulating hormone, thyroid-stimulating hormone, high-density lipoprotein cholesterol, baPWV, and BMD at the lumbar spine,
© 2014 S. Karger AG, Basel 0378–7346/14/0782–0124$39.50/0 E-Mail [email protected] www.karger.com/goi
femoral neck, and total hip sites. However, the eGFR according to the MDRD formula was significantly correlated with age and baPWV but not with BMD at the lumbar spine, femoral neck, and total hip sites. Decreased renal function (eGFR 1,500 cm/s) after adjusting for confounding variables. Conclusion: Postmenopausal women with decreased renal function are more likely to have a decreased BMD and greater arterial stiffness. © 2014 S. Karger AG, Basel
Introduction
Osteoporosis and cardiovascular disease (CVD) are major health problems that increase morbidity and mortality in postmenopausal women [1, 2]. Although menopausal hormone therapy (MHT) has been considered to be useful for the prevention of these diseases, MHT is currently not recommended as first-line treatment for osSeok Kyo Seo, MD Department of Obstetrics and Gynecology Severance Hospital, Yonsei University College of Medicine 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752 (Korea) E-Mail tudeolseo @ yuhs.ac
teoporosis and CVD in postmenopausal women [3–6]. Previous studies have shown that osteoporosis and atherosclerosis have common etiologic factors and underlying mechanisms, implying a possible pathophysiological connection between the two [7–9]. In postmenopausal women, osteoporosis has been demonstrated to be linked to CVD incidence and mortality, thus indicating a need for screening for both of these diseases in this population. A reduction in kidney function [or the estimated glomerular filtration rate (eGFR)] is an established risk factor for subclinical coronary artery calcification and is associated with a high prevalence of CVD and adverse CVD outcomes [10, 11]. Moreover, the glomerular filtration rate (GFR) is closely associated with arterial stiffness, which reflects the severity of vascular damage and the progression of atherosclerosis [12]. Furthermore, decreased renal function is associated with reduced bone mineral density (BMD) and an increased risk of hip fractures [13]. Accordingly, it has been suggested that measurements of the eGFR should be included in screening tests for identifying high-risk candidates in need of osteoporosis prophylaxis [14, 15]. However, little is currently known regarding the potential associations between renal function, BMD, and arterial stiffness in healthy postmenopausal women. Thus, in the present study, we investigated the effects of renal function (via the eGFR) on BMD and atherosclerosis in healthy postmenopausal women and estimated its potential as a screening method for identifying women at high risk for osteoporosis and CVD.
Materials and Methods
cer, or overt renal dysfunction (serum creatinine >1.5 mg/dl or eGFR
Received: August 29, 2013 Accepted after revision: May 18, 2014 Published online: July 11, 2014
Renal Function Is Associated with Bone Mineral Density and Arterial Stiffness in Healthy Postmenopausal Women Yeon Soo Jung a, c, e Hee-jin Hwang b Bo Hyon Yun c, e Seung Joo Chon c, e SiHyun Cho d, e Young Sik Choi c, e Young Tae Kim c, e Byung Seok Lee d, e Seok Kyo Seo c, e a
Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital Goyang, and Department of Family Medicine, Kwandong University College of Medicine, Goyang, and c Department of Obstetrics and Gynecology, Severance Hospital, and d Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, and e Institute of Woman’s Life Medical Science, Seoul, Korea b
Key Words Renal function · Bone mineral density · Arterial stiffness · Postmenopausal women
Abstract Background/Aims: This study aimed to investigate the effect of renal function on bone mineral density (BMD) and arterial stiffness in postmenopausal women. Methods: This is a retrospective cross-sectional study. We studied 252 postmenopausal women who visited a health promotion center for a medical checkup. The estimated glomerular filtration rate (eGFR) was calculated using the Cockcroft-Gault (CG) formula and the modification of diet in renal disease (MDRD) formula. Areal BMD measurements were performed using dual-energy X-ray absorptiometry, and arterial stiffness was measured using the brachial-ankle pulse wave velocity (baPWV). Results: The eGFR according to the CG formula was significantly correlated with age, BMI, follicle-stimulating hormone, thyroid-stimulating hormone, high-density lipoprotein cholesterol, baPWV, and BMD at the lumbar spine,
© 2014 S. Karger AG, Basel 0378–7346/14/0782–0124$39.50/0 E-Mail [email protected] www.karger.com/goi
femoral neck, and total hip sites. However, the eGFR according to the MDRD formula was significantly correlated with age and baPWV but not with BMD at the lumbar spine, femoral neck, and total hip sites. Decreased renal function (eGFR 1,500 cm/s) after adjusting for confounding variables. Conclusion: Postmenopausal women with decreased renal function are more likely to have a decreased BMD and greater arterial stiffness. © 2014 S. Karger AG, Basel
Introduction
Osteoporosis and cardiovascular disease (CVD) are major health problems that increase morbidity and mortality in postmenopausal women [1, 2]. Although menopausal hormone therapy (MHT) has been considered to be useful for the prevention of these diseases, MHT is currently not recommended as first-line treatment for osSeok Kyo Seo, MD Department of Obstetrics and Gynecology Severance Hospital, Yonsei University College of Medicine 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752 (Korea) E-Mail tudeolseo @ yuhs.ac
teoporosis and CVD in postmenopausal women [3–6]. Previous studies have shown that osteoporosis and atherosclerosis have common etiologic factors and underlying mechanisms, implying a possible pathophysiological connection between the two [7–9]. In postmenopausal women, osteoporosis has been demonstrated to be linked to CVD incidence and mortality, thus indicating a need for screening for both of these diseases in this population. A reduction in kidney function [or the estimated glomerular filtration rate (eGFR)] is an established risk factor for subclinical coronary artery calcification and is associated with a high prevalence of CVD and adverse CVD outcomes [10, 11]. Moreover, the glomerular filtration rate (GFR) is closely associated with arterial stiffness, which reflects the severity of vascular damage and the progression of atherosclerosis [12]. Furthermore, decreased renal function is associated with reduced bone mineral density (BMD) and an increased risk of hip fractures [13]. Accordingly, it has been suggested that measurements of the eGFR should be included in screening tests for identifying high-risk candidates in need of osteoporosis prophylaxis [14, 15]. However, little is currently known regarding the potential associations between renal function, BMD, and arterial stiffness in healthy postmenopausal women. Thus, in the present study, we investigated the effects of renal function (via the eGFR) on BMD and atherosclerosis in healthy postmenopausal women and estimated its potential as a screening method for identifying women at high risk for osteoporosis and CVD.
Materials and Methods
cer, or overt renal dysfunction (serum creatinine >1.5 mg/dl or eGFR
