Link Between Vascular Pathophysiology and Bone Metabolism Studied in Patients With Arthritis

Osteoporosis. Computer artwork of the trabeculae in the cancellous (spongy) bone tissue affected by osteoporosis. The cancellous tissue fills the interior of the bones and in osteoporosis its density decreases, increasing the brittleness of the bones and the probability of fractures. Osteoporosis usually affects women, above all after the menopause, because their ovaries no longer produce oestrogen hormones which help to maintain bone mass.
Researchers determined the correlation between vascular pathophysiology and bone metabolism in patients with rheumatoid arthritis and ankylosing spondylitis.

In patients with arthritis, vascular and bone disease may be driven by both systemic inflammation and disease activity, according to study results published in Scientific Reports.

Researchers determined the correlations between vascular pathophysiology and bone metabolism in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS), bone and vascular biomarkers and parameters, as well as the effect of 1-year antitumor necrosis factor (TNF) therapy on these markers in a 12-month follow-up study.

Overall, 36 patients with RA and 17 with AS who were selected for the initiation of anti-TNF therapy but unselected for cardiovascular disease and osteoporosis were enrolled in the current study. Patients with RA were receiving etanercept or certolizumab pegol and those with AS were receiving etanercept.

Multiple correlation analyses revealed that osteoprotegerin, sclerostin, and cathepsin K were significantly associated with flow-mediated vasodilation, common carotid intima-media thickness, and pulse-wave velocity, respectively (P <.05). Total and trabecular bone mineral density was inversely correlated with common carotid intima-media thickness (P <.05). Total and femoral bone mineral density were correlated with platelet-derived growth factor BB and common carotid intima-media thickness, respectively (P <.05).

According to repeated measures analysis of variance (RM-ANOVA) analysis, 1-year changes in common carotid intima-media thickness were determined by anti-TNF treatment along with baseline osteocalcin, procollagen 1 N-terminal propeptide, or vitamin D3 levels (P <.05). Multiple correlations between bone and vascular markers were affected by baseline disease activity indices (28-joint Disease Activity Score [DAS28], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), the 1-year changes in these indices, and C-reactive protein (P <.05).

The study was limited by the small number of patients, and therefore, the inability to make comparisons between patients with RA and AS and separately examine the effect of etanercept and certolizumab pegol.

According to the researchers, “Further studies are needed to evaluate the potential determinants of [cardiovascular disease] and [osteoporosis] and the relationship between bone and vascular pathology in inflammatory rheumatic diseases.”


Pusztai A, Hamar A, Czókolyová M, et al. Associations of vascular and bone status in arthritis patients. Sci Rep. 2021;11(1):19504. doi:10.1038/s41598-021-99071-9