Aortic stenosis (AS) will likely become increasingly frequent with the aging of the
American population. The difficulties in treating elderly patients with critical AS
emphasize the potential value of a strategy to slow the advancement of aortic valve
calcification. Recent prospective trials of statins and angiotensin-converting enzyme
inhibitors have been disappointing. New options are needed to achieve a truly effective
strategy for retarding the advancement of AS. In this context, the observations of
Skolnick et al appearing in this issue of The American Journal of Cardiology are particularly intriguing. In a retrospective review of patients followed for mild
or moderate AS, these investigators found that 18 patients receiving treatment for
osteoporosis had significantly less decrement in aortic valve area on follow-up echocardiography
than 37 not receiving such treatment. The most attractive explanation is an action
of drug therapy for osteoporosis, most often bisphosphonates, to retard aortic valve
calcification. The mechanism for this action is not clear, although numerous possibilities
can be postulated on the basis of the multiple complex processes controlling tissue
calcification. In conclusion, the investigators' findings deserve further study to
clarify drug impact on aortic valve calcification as well as confirm the clinical
findings in a larger and more diverse population. Such investigation should also assess
the role of vitamin D and calcium supplementation, common features of treatment for
osteoporosis. Currently available results are too preliminary to justify the use of
bisphosphonates or other osteoporosis therapies to slow the progression of AS.
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Article info
Publication history
Published online: May 21, 2009
Accepted:
February 25,
2009
Received in revised form:
February 25,
2009
Received:
February 18,
2009
Identification
Copyright
© 2009 Published by Elsevier Inc.
