骨–血管轴视角下骨质疏松与冠状动脉钙化的关联机制及一体化影像学筛查进展

Research Progress on the Correlation Mechanism between Osteoporosis and Coronary Artery Calcification and Integrated Imaging Screening from the Bone-Vascular Axis Perspective

摘要: 在全球人口老龄化加剧背景下，骨质疏松症与动脉粥样硬化性心血管疾病(ASCVD)已成为中老年人群主要致残、致死性慢性疾病，二者共病进一步加剧不良预后风险。“骨–血管轴”概念的提出揭示二者存在密切的内在关联，骨质疏松与冠状动脉钙化通过“骨–血管轴”形成紧密的病理关联，其共病机制涉及多系统、多通路的协同调控。胸部CT机会性筛查联合人工智能技术为两类疾病的早期识别与风险分层提供了可行的临床路径。但现有证据在因果关系、人群异质性及临床转化路径等方面仍存在争议。本文综合分析近年来国内外相关临床研究与基础实验成果，现有文献多单一探讨机制或影像技术，缺乏对人群异质性、效应修饰因子及临床落地障碍的整合分析。本文从五大维度系统归纳研究现状，剖析现存争议与瓶颈，并讨论该领域面临的挑战与发展趋势，旨在为心骨共病的机制解析、一体化影像筛查标准化及综合防控体系构建提供参考与理论支撑。

Abstract: Against the backdrop of accelerating global population aging, osteoporosis and atherosclerotic cardiovascular disease (ASCVD) have emerged as the leading chronic diseases causing disability and mortality among middle-aged and elderly populations, and their comorbidity further exacerbates the risk of adverse clinical outcomes. The proposal of the “bone-vascular axis” concept reveals an intimate intrinsic linkage between the two disorders. Osteoporosis and coronary artery calcification establish a tight pathological connection via the bone-vascular axis, and their comorbid mechanisms involve synergistic regulation across multiple systems and signaling pathways. Opportunistic chest CT screening combined with artificial intelligence technology provides a feasible clinical strategy for early identification and risk stratification of the two diseases. Nevertheless, controversies remain regarding existing evidence concerning causal relationships, population heterogeneity, and clinical translation pathways. This paper comprehensively analyzes relevant domestic and international clinical studies and basic experimental findings published in recent years. Most available literatures separately discuss pathological mechanisms or imaging techniques, lacking integrated analyses of population heterogeneity, effect modifiers, and barriers to clinical implementation. This review systematically summarizes current research advances from five dimensions, analyzes existing controversies and bottlenecks, and discusses challenges and future trends in this field, aiming to offer references and theoretical support for deciphering the mechanisms underlying bone-cardiac comorbidity, standardizing integrated imaging screening, and constructing a comprehensive prevention and control system.