Frequency of Osteoporosis in Patients with Coronary Heart Disease

Objectives: To explore and discuss the possible relationship between coronary artery disease and osteoporosis in men and in postmenopausal women in comparison with healthy control. Patients and methods: Fifty patients with ischemic heart diseases, with positive catheterization results whose ages range between 45 65 years old were enrolled in the study and referred as Group A. Fifty aapparently healthy subjects, matched for e with the patients group , were kept as control group and referred as Group B. We divided the patients understudy into two groups based on the mineral density they have; these groups are osteoporosis groupand normal bone mass group . Results: The frequency of bone density by using Dexa (T-score) in studied subjects in Group A were normal (T-score= 5.5 to -0.9) in 34 (68%) subjects, osteopenia (T• score= -1 to -2.4) in 11 (22%) subjects, and osteoporosis (T-score = -2.5) in 5 (10%) subjects. For Group B, 32 (64%) hainormal Dexa results, 17 (34%) were osteopenic, and 1 (2%) had osteoporosis. The study has found that the relationship between the two groups was not statistically significant when tested by the chi square test. Conclusion: There was no relationship between osteoporosis and cardiovascular diseases. Gender had no effects on osteoporosis.

which is a protein that regulates osteoclast activity and proliferation 7 . In spite of the above mentioned findings, the question that is to be raised is whether the age is the only factor that is to be taken into consideration as regard to this diseases, and if osteoporosis and coronary arterial disease are really related to each other or if they are independent processes. Thus more research is needed to find answers to the aforementioned questions in order to know how these two diseases are related to each other 8 .

Aim of the Study
The present study was aimed to seek the possible relationship between coronary artery disease and osteoporosis in men and in postmenopausal women in comparison with healthy control individuals.

Subjects, Materials and Methods
The current study was carried out during the period period between Nov. 011 and Jun 2012 in the Rheumatology outpatient department in Ebn Sena teaching hospital after taking the consent and approval of both the regional research committee of Mosul health dministration, and the scientific research committee of collage of medicine, university of Mosul, Mosul, Iraq, Study design Case -control study Subjects 1) Patients group: Fifty patients with lschemlc heart diseases, with positive catheterization results whose ages range between 45 -65 years old were enrolled in the study and referred as Group A. A. Exclusion criteria. were kept as control group and referred as Group B.

Data collection
In order to achieve the aims of the study ,the data of this study is collected by interviews and a questionnaire . The researcher has directly interviewed the subjects and designed a questionnaire that includes personal information such as age, sex, body weight in (kg), height in (m), BMI and biochemical profile (Appendix No.1).

Weight and height scale (secale) made in
Germany. Body mass index (BMI) was calculated according to the equation:BMI=weight(kg)/height (m2). 2. Dual-Energy X-Ray Absorptiometry: Bone mineral density (BMD) was obtained at lumbar vertebrae in all subjects using dual energy xray absorptiometry (the name of the apparatus).
T-Score classification as following:

Statistical Analysis
In order to be able to statistically analyze and test the results to find out the relationship between the parameters of the groups under study , we have used the following statistical means and tests : IBM SPSS Statistics Version 20.0 , Chi square and independent t-test .

RESULTS
Fifty patients in Group A their mean age + SD were 52.90 + 5.33, 28 (56%) of them were males and 22 (44%) were females. Fifty patients in Group B their mean age+SD were 52.22 6.36, 19 (38%) of them were males and 31 (62%) were females. No significant differences between mean age for studied groups by applying independent t-test for two means for each group Table 1 , and also There is no significant differences between both groups regarding gender by applying chi square test Table 2 .

Table1 :
The age of the studied groups. Independent t-test for two means was used. Chi-square test was used. The mean and standard deviation of Dexa results by using T-score for Group A were -0.38 + 1.63, and for Group B were -0.35 +1.28. There was no significant differences (P value= 0.137) between two groups by applying independant t-test Table 3 . Independent t-test for two means was used.
The chi square test (P value= 0.067) has shown that the relationship between the groups was not statistically significant. Table 4 . Chi-square test was used.
There was no effect of gender on Dexa results in both groups by using independent t• test for two means for each group. In Group A., the mean+SD of T-score in males were -0.217 + 1.798 and in females were -0.595 +1.388 (P value=0.588) ( Table-5). In GroupB, the mean+SD of Tscore in males were -0.631 + 1.505 and in females were -0.218 +1.163 (P value=0.1)  Independent t-test for two means was used. Independent t-te.st for two means was used.

DISCUSSION
Osteoporosis is one of the main diseases that cause health disorders universally. It is linked with fractures and consequently leads to death. Vascular calcification has been identified to be a disease that is not dependent risk factor for cardiovascular disease (CVD) 9 and these two diseases concurrently happening to aging process . It has been demonstrated that there are similar regulatory mechanisms between the common characteristics of atherosclerotic plaques, calcification, and those seen in bone metabolism 10 .
The sort of the supposed relationship between osteoporosis and cardiovascular disease is still not clear enough . Conventionally it is known that they are not related and their development was due to processes which are not related to age 11 . On the other hand, new studies have shown that the relationship between osteoporosis and cardiovascular ailment is not only due to the age factor , which is traditionally found in older populations .Thus there is a need to investigate the role of age factor in in younger populations. 11,12 . Despite of high percent (10%) of patients with cardiovascular problem had osteoporosis in comparison with control (2%), statistically! there was no significant association between cardiovascular disease and osteoporosis epresented by low bone density. This finding was consistent with others reported by , This study corresponds with Ayoagi et al who conducted a study on Japanese -American women and found out that osteoporosis and coronary atherosclerosis are two unrelated processes where age is one of the influencing factors in postmenopausal women and in men as well 11,12 . Also there was no significant association between osteoporosis and sex in this study, although the present study showed that females had a low mean of bone density than mal • but still statistically not significant. This can be explained by the fact that women are physically less active than men , and the instances of overweight and obesity can be found more in women than men as well as the sample size of this study was not enough to show this relation.
This can be explained by the fact that women are physically less active than men , and the instances of overweight and obesity can be found more in women than men furthermore, the association between cardiovascular disease and osteoporosis has been observed almost only in women 13,14,15 , raising further uncertainty whether the two disease processes are truly linked.
Moreover, both osteoporosis and cardiovascular diseases increase with age 11 and, in some studies, an association between bone mineral density (BMD) and cardiovascular diseases was lost once age was adjusted for 16 .
The present study showed normal mean level for T4 and TSH in both women and men regardless the result of T-score and was statistically not significant in both males and females. This result inconsistent with other studies that showed a positive relation between osteoporosis in postmenopausal women.