Osteoporosis in postmenopausal women: pathogenetic relationships with coronary heart disease and obesity (literature review)

Aim: to summarize and analysis of current literature data on the pathophysiological mechanisms of the relationship between osteoporosis, coronary heart disease and obesity in postmenopausal women. Materials and methods. A systematic analysis of scientific publications presented in the databases PubMed, Scopus, Web of Science, Google Scholar, as well as in national medical information resources of Ukraine was conducted. The work included scientific articles that met the inclusion criteria for the topic, completeness of the text, and relevance. Results. Osteoporosis, coronary heart disease, and obesity are the three most common diseases among postmenopausal women, which have a high level of medical and social significance due to their chronic course, high incidence of complications, and impact on functional capacity and quality of life. Estrogen deficiency in postmenopausal women is a key trigger for pathological changes in bone, metabolic, and vascular homeostasis. Recent studies demonstrate the presence of common pathogenetic links for these conditions, such as chronic low-level inflammation, endothelial dysfunction, estrogen deficiency, insulin resistance, lipid metabolism disorders, and adipokines imbalance. Decreased bone mineral density (BMD) correlates with atherosclerotic vascular lesions, and vascular calcification is often accompanied by bone loss. Osteotropic proteins are also found in vascular walls, indicating a biological transition between bone and vascular tissues. Low BMD is associated with an increased risk of cardiovascular mortality, especially in the elderly. Obesity also has a systemic negative impact on bone and cardiovascular health through activation of pro-inflammatory cytokines and stimulation of bone resorption. However, the current literature contains conflicting data on the impact of obesity on BMD: moderate excess body weight may have a protective effect on BMD loss, but obesity of II–III degree is significantly associated with an increased risk of osteoporotic fractures. This necessitates the need for risk stratification taking into account the degree of obesity and concomitant cardio-metabolic pathology. Conclusions. The presence of common pathogenetic mechanisms of osteoporosis, coronary heart disease, and obesity confirms the feasibility of developing comprehensive approaches to the prevention, early diagnosis, and treatment of these conditions in postmenopausal women.