Department of Medicine, Surgery and Neuroscience, University of Siena, Italy.
Division of Internal Medicine, General Hospital Misericordia, Grosseto, Italy.
Clin Interv Aging. 2017 Oct 30;12:1819-1828. doi: 10.2147/CIA.S138002. eCollection 2017.
Epidemiologic and clinical data have suggested the existence of a biologic linkage between the bone system and the vascular system. Bisphosphonates (BPs) are effective inhibitors of bone resorption and are currently considered the drugs of choice for the prevention and treatment of osteoporosis and related fractures. Data from several publications have suggested that BPs may also be effective in reducing the atherosclerotic process and vascular calcification, but the results of these studies are contrasting. This review aimed to allow a better understanding of the relationships between BPs and atherosclerosis in humans.
Electronic databases of Pubmed-Medline, Cochrane Library and SCOPUS from inception to June 30, 2016 were searched. The full texts of the articles potentially eligible were carefully assessed and reviewed. Finally, 20 studies were found to be eligible and were included in the systematic review. All included studies were published between 2000 and 2014.
In several studies, etidronate limited the progression of aortic and coronary calcification in hemodialysis patients, whereas the nitrogen-containing-BPs given orally did not significantly reduce vascular calcifications in patients with chronic kidney disease, kidney trasplant or in those with osteoporosis. Nitrogen-containing-BPs present favorable effects both on vessel wall thickness and on arterial elasticity due to both a reduction in serum lipids and the interaction of BPs with the bone tissue, with the consequent release of bone turnover markers and cytokines into the bloodstream.
To sum up, the BPs seem to have the potential of influencing atherosclerosis and calcium homeostasis at the level of vascular walls with several possible mechanisms which may differ according to the type, potency, dosage and administration route of BPs. Additional studies are needed to specifically address the mechanism by which BP use could influence cardiovascular morbidity and mortality.
流行病学和临床数据表明，骨骼系统和血管系统之间存在生物学联系。双膦酸盐（BPs）是有效的骨吸收抑制剂，目前被认为是预防和治疗骨质疏松症及相关骨折的首选药物。一些出版物的数据表明，BPs 可能也能有效减少动脉粥样硬化过程和血管钙化，但这些研究的结果却相互矛盾。本综述旨在更好地理解 BPs 与人类动脉粥样硬化之间的关系。
检索 Pubmed-Medline、Cochrane Library 和 SCOPUS 电子数据库，检索时间截至 2016 年 6 月 30 日。仔细评估和审查了可能符合条件的文章全文。最后，发现 20 项研究符合条件，并纳入系统评价。所有纳入的研究均发表于 2000 年至 2014 年。
在几项研究中，依替膦酸限制了血液透析患者的主动脉和冠状动脉钙化进展，而口服给予的含氮-BPs 并不能显著减少慢性肾脏病、肾移植或骨质疏松症患者的血管钙化。含氮-BPs 通过降低血清脂质和 BPs 与骨组织相互作用，从而释放骨转换标志物和细胞因子进入血液，对血管壁厚度和动脉弹性都有有利影响。
综上所述，BPs 似乎具有影响血管壁动脉粥样硬化和钙稳态的潜力，其可能的机制因 BPs 的类型、效力、剂量和给药途径而异。需要进一步的研究来专门探讨 BP 使用如何影响心血管发病率和死亡率的机制。
