Postmenopausal Osteoporosis, Endothelial Dysfunction, and Cardiovascular Risk

BACKGROUND/OBJECTIVES: Bone and cardiovascular health are interconnected, yet their relationship with endothelial function in postmenopausal osteoporosis remains insufficiently understood. This study aimed to investigate, in women with osteoporosis, the associations between endothelial function, assessed by flow-mediated dilation (FMD), bone turnover, and cardiovascular disease risk. METHODS: This cohort study included consecutive postmenopausal osteoporosis outpatients from the Rheumatology Department of Clermont-Ferrand University Hospital, France. FMD was measured at the brachial artery and values contextualized with age-matched healthy women's data reported in the literature. Associations between FMD and bone-related parameters (bone mineral density, bone markers, fracture history, and treatments), and Systematic Coronary Risk Evaluation (SCORE2/2-OP) were analyzed. RESULTS: A total of 111 postmenopausal women with osteoporosis (mean age 69.4 ± 7.9 y; mean FMD=3.14 ± 2.28%) were included. No significant associations were found between FMD and bone-related parameters. FMD was positively associated with prior bisphosphonate use (r=0.270, p=0.007) and inversely associated with SCORE2/2-OP (r=-0.212, p=0.035), particularly among younger participants. Overall, 49.5% of patients had high/very high SCORE2/2-OP, and 55% of those classified as low/intermediate SCORE2/2-OP exhibited low FMD values. CONCLUSIONS: Measurement of the endothelial function in postmenopausal osteoporosis brings additional information to cardiovascular risk calculation, suggesting that factors beyond traditional cardiovascular risk determinants contribute to vascular impairment. In clinical practice, our findings support cautious cardiovascular follow-up even in osteoporotic patients with low cardiovascular risk and underline possible positive effects of bisphosphonates on endothelial function.