Introduction: Atherosclerosis and osteoporosis are two major public health problems. These are both multifactorial and degenerative diseases that accompany aging. Co-morbidities are common, with a high prevalence of cardiovascular risk factors including hypertension, smoking, and sedentary lifestyle. Several studies have suggested a relationship between atherosclerosis and osteoporosis, with a significant correlation between coronary artery calcium and bone mineral density (BMD). The pulsatility index (PI) is designed to measure vascular resistance and characterizes the shape of the spectral waveform. The PI was increasing with age but alterations in PI are the reflection of multifactorial, pleiotropic events occurring in the cardio and cerebral vascular system. Atherosclerosis of the large proximal arteries and the intracranial vessels are important factors for increased PI.
Hypothesis: We hypothesized that the transcranial Doppler (TCD) PI would reflect the atherosclerotic component of intracranial vessels which in turn is related to systemic atherosclerosis. In this context, we investigated the relationship between TCD PI and BMD in acute ischemic stroke patients.
Methods: Patients having their first ischemic stroke within 7 days were screened for the study. Doppler signals from the main stem of the middle cerebral artery (MCA) were obtained transtemporally with a traditional 2-MHz transducer at depths of 56, 58, and 60 mm. BMD was measured at total hip and lumbar spine in the anterior-posterior projection, using dual-energy x-ray absorptiometry.
Results: A total of 146 patients were enrolled in the study and the mean age was 68.3±10.34 years. Multiple linear regression analysis reveals that age (p<0.001) and BMD T-score (p=0.028) were significantly associated with increased TCD PI. Old age and decreased T-score were significantly related to increased TCD PI. Age adjusted scatterplots showed that BMD T-score was inversely related to TCD PI in acute ischemic stroke patients (r=-0.202, p=0.028).
Conclusions: Our findings indicate that decreased BMD may be associated with atherosclerosis in the cerebral circulation.