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Osteoporosis—a risk factor for cardiovascular disease?

Nature Reviews Rheumatology volume 8, pages 587–598 (2012)Cite this article

Subjects

Abstract

Osteoporosis is a serious health problem worldwide that is associated with an increased risk of fractures and mortality. Vascular calcification is a well-defined independent risk factor for cardiovascular disease (CVD) and mortality. Major advances in our understanding of the pathophysiology of osteoporosis and vascular calcification indicate that these two processes share common pathogenetic mechanisms. Multiple factors including proteins (such as bone morphogenetic proteins, receptor activator of nuclear factor κB ligand, osteoprotegerin, matrix Gla protein and cathepsins), parathyroid hormone, phosphate, oxidized lipids and vitamins D and K are implicated in both bone and vascular metabolism, illustrating the interaction of these two, seemingly unrelated, conditions. Many clinical studies have now confirmed the correlation between osteoporosis and vascular calcification as well as the increased risk of CVD in patients with osteoporosis. Here, we explore the proposed mechanistic similarities between osteoporosis and vascular calcification and present an overview of the clinical data that support the interaction between these conditions.

Key Points

  • Osteoporosis and vascular calcification share common pathogenetic mechanisms, involving bone morphogenetic proteins, the RANKL–RANK–OPG pathway, MGP and vitamin K

  • Patients with osteoporosis have higher levels of vascular calcification than those with normal bone mineral density

  • Clinical evidence reveals that osteoporosis is associated with cardiovascular events and increased mortality; moreover, vascular calcification is related to an increased risk of fracture

  • In patients with osteoporosis, cardiac and/or vascular calcification can be easily detected by use of simple screening tests, such as ultrasonography of the heart and carotid arteries, or thoracic and abdominal radiography

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Figure 1: Common pathogenetic mechanisms in vascular calcification and osteoporosis.

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Authors and Affiliations

  1. Department of Internal Medicine, General Hospital of Nafplio, Kolokotroni and Asklipiou Streets, Nafplio, 21100, Greece

    Christos E. Lampropoulos

  2. Branch of Public Hygiene, Ministry of Health, 17 Aristotelous Street, Athens, 10187, Greece

    Ioanna Papaioannou

  3. Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, 4 Lambeth Palace Road, London, SE1 7EH, UK

    David P. D'Cruz

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  1. Christos E. Lampropoulos
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  2. Ioanna Papaioannou
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  3. David P. D'Cruz
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C. E. Lampropoulos and I. Papaioannou researched data for the article, all authors provided a substantial contribution to discussions of the content, C. E. Lampropoulos wrote the article, and C. E. Lampropoulos and D. P. D'Cruz reviewed and/or edited the article before submission.

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Correspondence to David P. D'Cruz.

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Lampropoulos, C., Papaioannou, I. & D'Cruz, D. Osteoporosis—a risk factor for cardiovascular disease?. Nat Rev Rheumatol 8, 587–598 (2012). https://doi.org/10.1038/nrrheum.2012.120

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