Exploring the Links Between Common Diseases of AgeingOsteoporosis, Sarcopenia and Vascular Calcification

Vascular diseases account for a significant proportion of preventable deaths, particularly in developed countries. Our understanding of diseases that alter the structure and function of blood vessels such as vascular calcification and vascular stiffness has grown enormously such that we now appreciate them to be active processes that can be modified. Interest has also grown in examining the links between other diseases of ageing such as the loss of bone (osteoporosis) and muscle (sarcopenia) with the development and progression of vascular disease as these three disease states commonly co-occur in older age. Cardiovascular disease (including calcification and arterial stiffness) is highly prevalent in older populations and it appears that its progression is accelerated in patients with osteoporosis, fracture, sarcopenia and in those who are functionally impaired. Biological and clinical evidence supports a view that vascular disease (calcification/stiffness) may be both a cause and consequence of diseases of ageing including musculoskeletal decline. This review provides an overview of the development of vascular calcification and stiffness and explores the molecular and physiological mechanisms linking osteoporosis and sarcopenia to vascular disease development. This review also examines clinical evidence supporting the association of muscle and bone loss with vascular disease and concludes by reviewing the interventional and therapeutic potential of bone-active minerals and hormones (calcium and vitamin D) on cardiovascular disease biology, given that these represent potential interventions to target multiple body systems. Overall, this review will aim to highlight the underappreciated burden of cardiovascular disease in individuals in the context of musculoskeletal diseases.