Department of Rheumatology, VU Medical Centre, De Boelelaan 1117, 1081 NV Amsterdam, The Netherlands.
Arthritis Res Ther. 2011 Jan 17;13(1):R5. doi: 10.1186/ar3224.
Both cardiovascular disease and osteoporosis are important causes of morbidity and mortality in the elderly. The co-occurrence of cardiovascular disease and osteoporosis prompted us to review the evidence of an association between cardiovascular (CV) disease and osteoporosis and potential shared common pathophysiological mechanisms.
A systematic literature search (Medline, Pubmed and Embase) was conducted to identify all clinical studies that investigated the association between cardiovascular disease and osteoporosis. Relevant studies were screened for quality according to guidelines as proposed by the Dutch Cochrane Centre and evidence was summarized.
Seventy studies were included in this review. Due to a large heterogeneity in study population, design and outcome measures a formal meta-analysis was not possible. Six of the highest ranked studies (mean n = 2,000) showed that individuals with prevalent subclinical CV disease had higher risk for increased bone loss and fractures during follow-up compared to persons without CV disease (range of reported risk: hazard ratio (HR) 1.5; odds ratio (OR) 2.3 to 3.0). The largest study (n = 31,936) reported a more than four times higher risk in women and more than six times higher risk in men. There is moderate evidence that individuals with low bone mass had higher CV mortality rates and incident CV events than subjects with normal bone mass (risk rates 1.2 to 1.4). Although the shared common pathophysiological mechanisms are not fully elucidated, the most important factors that might explain this association appear to be, besides age, estrogen deficiency and inflammation.
The current evidence indicates that individuals with prevalent subclinical CV disease are at increased risk for bone loss and subsequent fractures. Presently no firm conclusions can be drawn as to what extent low bone mineral density might be associated with increased cardiovascular risk.
心血管疾病和骨质疏松症都是老年人发病率和死亡率的重要原因。心血管疾病和骨质疏松症的同时发生促使我们回顾心血管疾病与骨质疏松症之间的关联证据，并探讨潜在的共同病理生理机制。
系统检索了 Medline、Pubmed 和 Embase 中的文献，以确定所有研究心血管疾病与骨质疏松症之间关联的临床研究。根据荷兰 Cochrane 中心提出的指南筛选相关研究的质量，并对证据进行总结。
本综述纳入了 70 项研究。由于研究人群、设计和结局测量指标存在较大异质性，因此无法进行正式的荟萃分析。其中 6 项最高质量的研究（平均 n = 2000 人）表明，患有亚临床心血管疾病的个体在随访期间发生骨量丢失和骨折的风险高于无心血管疾病的个体（报告的风险范围：风险比（HR）为 1.5；优势比（OR）为 2.3 至 3.0）。最大的研究（n = 31936 人）报告称，女性的风险增加超过四倍，男性的风险增加超过六倍。有中等质量证据表明，骨量低的个体心血管死亡率和心血管事件发生率高于骨量正常的个体（风险率为 1.2 至 1.4）。尽管共同的病理生理机制尚未完全阐明，但可以解释这种关联的最重要因素除了年龄、雌激素缺乏和炎症外，似乎还包括这些因素。
目前的证据表明，患有亚临床心血管疾病的个体发生骨丢失和随后骨折的风险增加。目前尚不能确定骨密度低与心血管风险增加之间有多大程度的关联。
