Vascular Disease and the Skeleton

This chapter briefly relates the vital interplay between vascular biology and bone physiology as relevant to metabolic bone disease. It reviews data that highlight how prevalent vascular disease processes impair skeletal homeostatic mechanisms. Avascular necrosis (AVN), or osteonecrosis, represents the best-recognized clinical disorder of vascular disease and the skeleton. Demer, Tintut, and colleagues recently demonstrated that multiple oxylipids derived from LDL-a key contributor to atherosclerosis and arteriosclerosis-suppresses osteoblastmediated bone formation, enhances T-cell receptor activator of nuclear factor-kappa B ligand (RANKL) production, and impairs skeletal anabolic responses to PTH. The perspectives of experts in endocrinology, cardiology, developmental biology, orthopedics, biochemistry, genetics, pathology, engineering and hematology often emphasize different features of the relationship between the vasculature and bone. This integrated picture provides a "toolbox" for devising novel strategies to address unmet needs in skeletal health.