循环系统疾病与继发性骨质疏松症的研究新进展

doi:10.12114/j.issn.1007-9572.2024.0687

摘要/Abstract

摘要： 继发性骨质疏松症（SOP）在临床实践中容易被忽视，尤其是高血压、冠心病、慢性心力衰竭、心房颤动等循环系统疾病继发骨质疏松时，由于循环系统疾病的复杂性及治疗药物的不良反应，其继发骨质疏松的风险常被低估，及早预防和治疗SOP对于提高患者的生活质量至关重要。不同类型疾病引起骨代谢失衡的机制与治疗方案各有不同，本文将从流行病学特征、相关危险因素与发病机制、骨代谢变化与骨损害特点及诊治进展4个方面对常见循环系统疾病合并骨质疏松进行综述，以期为循环系统疾病患者合并骨质疏松防治提供参考。

关键词: 继发性骨质疏松症, 骨质疏松, 高血压, 冠心病, 慢性心力衰竭, 心房颤动, 治疗

Abstract:

Secondary osteoporosis (OP) is easy to be ignored in clinical practice, especially secondary OP caused by hypertension, coronary heart disease, chronic heart failure, atrial fibrillation and other circulatory system diseases. Due to the complexity of circulatory system diseases and adverse reactions of therapeutic drugs, the risk of secondary OP is often underestimated. Early prevention and treatment of secondary OP is very important to improve the quality of life of patients. The mechanism and treatment scheme of bone metabolism imbalance caused by different types of diseases are different. This article will review the common circulatory system diseases complicated with OP from the aspects of epidemiological characteristics, related risk factors and pathogenesis, changes of bone metabolism and characteristics of bone damage, as well as the progress of diagnosis and treatment, in order to provide reference for the prevention and treatment of circulatory system diseases complicated with OP.

Key words: Secondary osteoporosis, Osteoporosis, Hypertension, Coronary heart disease, Chronic heart failure, Atrial fibrillation, Treatment

贺婷,李佳,谭文彬. 循环系统疾病与继发性骨质疏松症的研究新进展[J]. 中国全科医学, 2025, 28(17): 2101-2112. DOI: 10.12114/j.issn.1007-9572.2024.0687.
HE Ting,LI Jia,TAN Wenbin. Research Progress of Circulatory System Diseases and Secondary Osteoporosis[J]. Chinese General Practice, 2025, 28(17): 2101-2112. DOI: 10.12114/j.issn.1007-9572.2024.0687.

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参考文献 102

[1]	ZHANG J S, XU P, LIU R C, et al. Osteoporosis and coronary heart disease：a bi-directional mendelian randomization study[J]. Front Endocrinol，2024，15：1362428. DOI：10.3389/fendo.2024.1362428.
[2]	HUANG Y Q, YE J Y. Association between hypertension and osteoporosis：a population-based cross-sectional study[J]. BMC Musculoskelet Disord，2024，25(1)：434. DOI：10.1186/s12891-024-07553-4.
[3]	WU H L, YANG J, WEI Y C, et al. Analysis of the prevalence，risk factors，and clinical characteristics of osteoporosis in patients with essential hypertension[J]. BMC Endocr Disord，2022，22(1)：165. DOI：10.1186/s12902-022-01080-w.
[4]	CHAI H, GE J R, LI L, et al. Hypertension is associated with osteoporosis：a case-control study in Chinese postmenopausal women[J]. BMC Musculoskelet Disord，2021，22(1)：253. DOI：10.1186/s12891-021-04124-9.
[5]	LI C, ZENG Y, TAO L, et al. Meta-analysis of hypertension and osteoporotic fracture risk in women and men[J]. Osteoporos Int，2017，28(8)：2309-2318. DOI：10.1007/s00198-017-4050-z.
[6]	HU Z Q, YANG K, HU Z H, et al. Determining the association between hypertension and bone metabolism markers in osteoporotic patients[J]. Medicine，2021，100(24)：e26276. DOI：10.1097/MD.0000000000026276.
[7]	ASABA Y, ITO M, FUMOTO T, et al. Activation of renin-angiotensin system induces osteoporosis independently of hypertension[J]. J Bone Miner Res，2009，24(2)：241-250. DOI：10.1359/jbmr.081006.
[8]	KIM K M, HWANG E J, LEE S J, et al. The impact of Renin-Angiotensin System Inhibitors on bone fracture risk：a nationwide nested case-control study[J]. BMC Musculoskelet Disord，2024，25(1)：3. DOI：10.1186/s12891-023-07102-5.
[9]	ZHAO J J, YANG H, CHEN B, et al. The skeletal renin-angiotensin system：a potential therapeutic target for the treatment of osteoarticular diseases[J]. Int Immunopharmacol，2019，72：258-263. DOI：10.1016/j.intimp.2019.04.023.
[10]	PRAMUSITA A, KITAURA H, OHORI F, et al. Salt-sensitive hypertension induces osteoclastogenesis and bone resorption via upregulation of angiotensinⅡ typeⅠ receptor expression in osteoblasts[J]. Front Cell Dev Biol，2022，10：816764. DOI：10.3389/fcell.2022.816764.
[11]	TIYASATKULKOVIT W, PROMRUK W, ROJVIRIYA C, et al. Impairment of bone microstructure and upregulation of osteoclastogenic markers in spontaneously hypertensive rats[J]. Sci Rep，2019，9(1)：12293. DOI：10.1038/s41598-019-48797-8.
[12]	WU T L, LIN Z B, WANG C Z, et al. Correlation between vitamin D levels and blood pressure in elderly hypertensive patients with osteoporosis[J]. Front Med，2024，11：1396254. DOI：10.3389/fmed.2024.1396254.
[13]	CHEN X, HE B B, ZHOU Y L, et al. Investigating the effect of history of fractures and hypertension on the risk of all-cause death from osteoporosis：a retrospective cohort study[J]. Medicine，2023，102(13)：e33342. DOI：10.1097/MD.0000000000033342.
[14]	HIJAZI N, ALOURFI Z. Association between hypertension，antihypertensive drugs，and osteoporosis in postmenopausal Syrian women：a cross-sectional study[J]. Adv Med，2020，2020：7014212. DOI：10.1155/2020/7014212.
[15]	BONNET N, BENHAMOU C L, MALAVAL L, et al. Low dose beta-blocker prevents ovariectomy-induced bone loss in rats without affecting heart functions[J]. J Cell Physiol，2008，217(3)：819-827. DOI：10.1002/jcp.21564.
[16]	ZHANG R X, YIN H T, YANG M D, et al. Advanced progress of the relationship between antihypertensive drugs and bone metabolism[J]. Hypertension，2023，80(11)：2255-2264. DOI：10.1161/HYPERTENSIONAHA.123.21648.
[17]	SONG S W, CAI X T, HU J L, et al. Effectiveness of spironolactone in reducing osteoporosis and future fracture risk in middle-aged and elderly hypertensive patients[J]. Des Dev Ther，2024，18：2215-2225. DOI：10.2147/DDDT.S466904.
[18]	SYU D K, HSU S H, YEH P C, et al. The association between coronary artery disease and osteoporosis：a population-based longitudinal study in Taiwan[J]. Arch Osteoporos，2022，17(1)：91. DOI：10.1007/s11657-022-01128-3.
[19]	GERBER Y, JOSEPH MELTON L 3rd, WESTON S A, et al. Association between myocardial infarction and fractures：an emerging phenomenon[J]. Circulation，2011，124(3)：297-303. DOI：10.1161/CIRCULATIONAHA.110.007195.
[20]	王志敏，张颖辉，闫昱杉，等. 郑州中老年居民冠心病与骨质疏松性骨折的相关性[J]. 中华骨质疏松和骨矿盐疾病杂志，2021，14(1)：16-22. DOI：10.3969/j.issn.1674-2591.2021.01.003.
[21]	LIU N J, CHEN J, ZHANG K Q, et al. A community-based study of the relationship between coronary artery disease and osteoporosis in Chinese postmenopausal women[J]. Coron Artery Dis，2016，27(1)：59-64. DOI：10.1097/MCA.0000000000000306.
[22]	WANG X, REN J, FANG F, et al. Matrix vesicles from osteoblasts promote atherosclerotic calcification[J]. Matrix Biol，2024，134：79-92. DOI：10.1016/j.matbio.2024.09.003.
[23]	KIEL D P, KAUPPILA L I, CUPPLES L A, et al. Bone loss and the progression of abdominal aortic calcification over a 25 year period：the Framingham Heart Study[J]. Calcif Tissue Int，2001，68(5)：271-276. DOI：10.1007/BF02390833.
[24]	ASADI M, RAZI F, FAHIMFAR N, et al. The association of coronary artery calcium score and osteoporosis in postmenopausal women：a cross-sectional study[J]. J Bone Metab，2022，29(4)：245-254. DOI：10.11005/jbm.2022.29.4.245.
[25]	ZHANG Y Y, FENG B. Systematic review and meta-analysis for the association of bone mineral density and osteoporosis/osteopenia with vascular calcification in women[J]. Int J Rheum Dis，2017，20(2)：154-160. DOI：10.1111/1756-185X.12842.
[26]	GU W, WANG Z Q, SUN Z, et al. Role of NFATc1 in the bone-vascular axis calcification paradox[J]. J Cardiovasc Pharmacol，2020，75(3)：200-207. DOI：10.1097/FJC.0000000000000788.
[27]	WEI R, ZHANG Y X, HUANG M X, et al. Associations between bone mineral density and abdominal aortic calcification：Results of a nationwide survey[J]. Nutr Metab Cardiovasc Dis，2024，34(6)：1488-1495. DOI：10.1016/j.numecd.2024.01.031.
[28]	VALERO C, GONZÁLEZ MACÍAS J. Atherosclerosis，vascular calcification and osteoporosis[J]. Med Clínica Engl Ed，2025，164(4)：e13-e20. DOI：10.1016/j.medcle.2025.02.001.
[29]	HOFBAUER L C, BRUECK C C, SHANAHAN C M, et al. Vascular calcification and osteoporosis—from clinical observation towards molecular understanding[J]. Osteoporos Int，2007，18(3)：251-259. DOI：10.1007/s00198-006-0282-z.
[30]	HALLORAN D, DURBANO H W, NOHE A. Bone morphogenetic protein-2 in development and bone homeostasis[J]. J Dev Biol，2020，8(3)：19. DOI：10.3390/jdb8030019.
[31]	THOMPSON B, TOWLER D A. Arterial calcification and bone physiology：role of the bone-vascular axis[J]. Nat Rev Endocrinol，2012，8(9)：529-543. DOI：10.1038/nrendo.2012.36.
[32]	KRISHNAN V, BRYANT H U, MACDOUGALD O A. Regulation of bone mass by Wnt signaling[J]. J Clin Invest，2006，116(5)：1202-1209. DOI：10.1172/JCI28551.
[33]	CATALANO A, BELLONE F, MORABITO N, et al. Sclerostin and vascular pathophysiology[J]. Int J Mol Sci，2020，21(13)：4779. DOI：10.3390/ijms21134779.
[34]	ANAGNOSTIS P, KARAGIANNIS A, KAKAFIKA A I, et al. Atherosclerosis and osteoporosis：age-dependent degenerative processes or related entities?[J]. Osteoporos Int，2009，20(2)：197-207. DOI：10.1007/s00198-008-0648-5.
[35]	ANAGNOSTIS P, FLORENTIN M, LIVADAS S, et al. Bone health in patients with dyslipidemias：an underestimated aspect[J]. Int J Mol Sci，2022，23(3)：1639. DOI：10.3390/ijms23031639.
[36]	ZHANG Y H, HE B, WANG H J, et al. Associations between bone mineral density and coronary artery disease：a meta-analysis of cross-sectional studies[J]. Arch Osteoporos，2020，15(1)：24. DOI：10.1007/s11657-020-0691-1.
[37]	郭路，王玉丹，侯晓丽，等. 心脑血管疾病与骨质疏松性骨折的相关性[J]. 中华骨质疏松和骨矿盐疾病杂志，2022，15(6)：683-690. DOI：10.3969/j.issn.1674-2591.2022.06.011.
[38]	LI G H, CHEUNG C L, AU P C, et al. Positive effects of low LDL-C and statins on bone mineral density：an integrated epidemiological observation analysis and Mendelian randomization study[J]. Int J Epidemiol，2020，49(4)：1221-1235. DOI：10.1093/ije/dyz145.
[39]	HONG W, WEI Z Y, QIU Z H, et al. Atorvastatin promotes bone formation in aged apoE-/- mice through the Sirt1-Runx2 axis[J]. J Orthop Surg Res，2020，15(1)：303. DOI：10.1186/s13018-020-01841-0.
[40]	ZHU J X, ZHANG C G, JIA J L, et al. Osteogenic effects in a rat osteoporosis model and femur defect model by simvastatin microcrystals[J]. Ann N Y Acad Sci，2021，1487(1)：31-42. DOI：10.1111/nyas.14513.
[41]	XIONG M X, XUE Y J, ZHU W, et al. Comparative efficacy and safety of statins for osteoporosis：a study protocol for a systematic review and network meta-analysis[J]. BMJ Open，2022，12(5)：e054158. DOI：10.1136/bmjopen-2021-054158.
[42]	ASADIPOOYA K, WEINSTOCK A. Cardiovascular outcomes of romosozumab and protective role of alendronate[J]. Arterioscler Thromb Vasc Biol，2019，39(7)：1343-1350. DOI：10.1161/atvbaha.119.312371.
[43]	LIM S Y, BOLSTER M B. Clinical utility of romosozumab in the management of osteoporosis：focus on patient selection and perspectives[J]. Int J Womens Health，2022，14：1733-1747. DOI：10.2147/IJWH.S315184.
[44]	SAAG K G, PETERSEN J, BRANDI M L, et al. Romosozumab or alendronate for fracture prevention in women with osteoporosis[J]. N Engl J Med，2017，377(15)：1417-1427. DOI：10.1056/NEJMoa1708322.
[45]	COSMAN F, CRITTENDEN D B, ADACHI J D, et al. Romosozumab treatment in postmenopausal women with osteoporosis[J]. N Engl J Med，2016，375(16)：1532-1543. DOI：10.1056/NEJMoa1607948.
[46]	CUMMINGS S R, MCCULLOCH C. Explanations for the difference in rates of cardiovascular events in a trial of alendronate and romosozumab[J]. Osteoporos Int，2020，31(6)：1019-1021. DOI：10.1007/s00198-020-05379-z.
[47]	WONG R M Y, WONG P Y, LIU C R, et al. Treatment effects，adverse outcomes and cardiovascular safety of romosozumab-Existing worldwide data：a systematic review and meta-analysis[J]. J Orthop Translat，2024，48：107-122. DOI：10.1016/j.jot.2024.07.011.
[48]	TOMINAGA R, et al. Comparative cardiovascular safety of romosozumab versus bisphosphonates in Japanese patients with osteoporosis：a new-user，active comparator design with instrumental variable analyses[J]. J Bone Miner Res，2025：zjaf010. DOI：10.1093/jbmr/zjaf010.
[49]	KHALID S, CALDERON-LARRANAGA S, SAMI A, et al. Comparative risk of acute myocardial infarction for anti-osteoporosis drugs in primary care：a meta-analysis of propensity-matched cohort findings from the UK Clinical Practice Research Database and the Catalan SIDIAP Database[J]. Osteoporos Int，2022，33(7)：1579-1589. DOI：10.1007/s00198-021-06262-1.
[50]	SPANGLER L, NIELSON C M, BROOKHART M A, et al. Cardiovascular safety in postmenopausal women and men with osteoporosis treated with denosumab and zoledronic acid：a post-authorization safety study[J]. JBMR Plus，2023，7(10)：e10793. DOI：10.1002/jbm4.10793.
[51]	高增杰，覃裕，宋红. 补钙的心血管风险与获益[J]. 中华骨质疏松和骨矿盐疾病杂志，2021，14(5)：531-536. DOI：10.3969/j.issn.1674-2591.2021.05.013.
[52]	BOLLAND M J, AVENELL A, BARON J A, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events：meta-analysis[J]. BMJ，2010，341：c3691. DOI：10.1136/bmj.c3691.
[53]	MICHAËLSSON K, MELHUS H, WARENSJÖ LEMMING E, et al. Long term calcium intake and rates of all cause and cardiovascular mortality：community based prospective longitudinal cohort study[J]. BMJ，2013，346：f228. DOI：10.1136/bmj.f228.
[54]	LEWIS J R, RADAVELLI-BAGATINI S, REJNMARK L, et al. The effects of calcium supplementation on verified coronary heart disease hospitalization and death in postmenopausal women：a collaborative meta-analysis of randomized controlled trials[J]. J Bone Miner Res，2015，30(1)：165-175. DOI：10.1002/jbmr.2311.
[55]	CHUNG M, TANG A M, FU Z X, et al. Calcium intake and cardiovascular disease risk：an updated systematic review and meta-analysis[J]. Ann Intern Med，2016，165(12)：856-866. DOI：10.7326/M16-1165.
[56]	NAGHSHI S, NAEMI M, SADEGHI O, et al. Total，dietary，and supplemental calcium intake and risk of all-cause cardiovascular，and cancer mortality：a systematic review and dose-response meta-analysis of prospective cohort studies[J]. Crit Rev Food Sci Nutr，2022，62(21)：5733-5743. DOI：10.1080/10408398.2021.1890690.
[57]	LEE J K, TRAN T M C, CHOI E, et al. Association between daily dietary calcium intake and the risk of cardiovascular disease（CVD）in postmenopausal Korean women[J]. Nutrients，2024，16(7)：1043. DOI：10.3390/nu16071043.
[58]	中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊疗指南（2022）[J]. 中华骨质疏松和骨矿盐疾病杂志，2022，15(6)：573-611. DOI：10.3969/j.issn.1674-2591.2022.06.001.
[59]	AASETH J O, FINNES T E, ASKIM M, et al. The importance of vitamin K and the combination of vitamins K and D for calcium metabolism and bone health：a review[J]. Nutrients，2024，16(15)：2420. DOI：10.3390/nu16152420.
[60]	KATANO S, YANO T, TSUKADA T, et al. Clinical risk factors and prognostic impact of osteoporosis in patients with chronic heart failure[J]. Circ J，2020，84(12)：2224-2234. DOI：10.1253/circj.cj-20-0593.
[61]	VERHEYEN N, SCHMID J, KOLESNIK E, et al. Prevalence and prognostic impact of bone disease in chronic heart failure with reduced ejection fraction[J]. ESC Heart Fail，2024，11(3)：1730-1738. DOI：10.1002/ehf2.14741.
[62]	LONCAR G, CVETINOVIC N, LAINSCAK M, et al. Bone in heart failure[J]. J Cachexia Sarcopenia Muscle，2020，11(2)：381-393. DOI：10.1002/jcsm.12516.
[63]	ARNETT T R, GIBBONS D C, UTTING J C, et al. Hypoxia is a major stimulator of osteoclast formation and bone resorption[J]. J Cell Physiol，2003，196(1)：2-8. DOI：10.1002/jcp.10321.
[64]	ABE H, SEMBA H, TAKEDA N. The roles of hypoxia signaling in the pathogenesis of cardiovascular diseases[J]. J Atheroscler Thromb，2017，24(9)：884-894. DOI：10.5551/jat.RV17009.
[65]	GE G, LI J, WANG Q. Heart failure and fracture risk：a meta-analysis[J]. Osteoporos Int，2019，30(10)：1903-1909. DOI：10.1007/s00198-019-05042-2.
[66]	GUAN Z Y, YUAN W Q, JIA J L, et al. Bone mass loss in chronic heart failure is associated with sympathetic nerve activation[J]. Bone，2023，166：116596. DOI：10.1016/j.bone.2022.116596.
[67]	XING W M, LV X L, GAO W Y, et al. Bone mineral density in patients with chronic heart failure：a meta-analysis[J]. Clin Interv Aging，2018，13：343-353. DOI：10.2147/CIA.S154356.
[68]	LONCAR G, GARFIAS-VEITL T, VALENTOVA M, et al. Bone status in men with heart failure：results from the Studies Investigating co-morbidities Aggravating Heart Failure[J]. Eur J Heart Fail，2023，25(5)：714-723. DOI：10.1002/ejhf.2794.
[69]	BANDEIRA F, OLIVEIRA L B, CALDEIRA R B, et al. Skeletal consequences of heart failure[J]. Womens Health，2022，18：17455057221135501. DOI：10.1177/17455057221135501.
[70]	DE OLIVEIRA L B, DE FIGUEIREDO MARTINS SIQUEIRA M A, DE MACEDO GADÊLHA R B, et al. Bone mineral density，trabecular bone score and fractures in patients hospitalized for heart failure[J]. J Bone Metab，2023，30(2)：167-177. DOI：10.11005/jbm.2023.30.2.167.
[71]	NUMAZAWA R, KATANO S, YANO T, et al. Development and validation of osteoporosis risk assessment score in patients with heart failure：comparison with the osteoporosis self-assessment tool for Asians[J]. Eur J Cardiovasc Nurs，2024，23(4)：408-417. DOI：10.1093/eurjcn/zvad089.
[72]	LIU X P, JIAN X Y, LIANG D L, et al. The association between heart failure and risk of fractures：Pool analysis comprising 260，410 participants[J]. Front Cardiovasc Med，2022，9：977082. DOI：10.3389/fcvm.2022.977082.
[73]	HEO J H, RASCATI K L, LOPEZ K N, et al. Increased fracture risk with furosemide use in children with congenital heart disease[J]. J Pediatr，2018，199：92-98.e10. DOI：10.1016/j.jpeds.2018.03.077.
[74]	MARTENS P, TER MAATEN J M, VANHAEN D, et al. Heart failure is associated with accelerated age related metabolic bone disease[J]. Acta Cardiol，2021，76(7)：718-726. DOI：10.1080/00015385.2020.1771885.
[75]	CARBONE L D, CROSS J D, RAZA S H, et al. Fracture risk in men with congestive heart failure risk reduction with spironolactone[J]. J Am Coll Cardiol，2008，52(2)：135-138. DOI：10.1016/j.jacc.2008.03.039.
[76]	吕若琳，刘松，徐丽丽，等. 钠-葡萄糖共转运体2抑制剂：超越降糖作用的心肾保护作用及对2型糖尿病患者骨代谢和骨折风险的影响[J]. 中华内分泌代谢杂志，2022，38(9)：823-829. DOI：10.3760/cma.j.cn311282-20220618-00388.
[77]	WIKAREK A, GRABARCZYK M, KLIMEK K, et al. Effect of drugs used in pharmacotherapy of type 2 diabetes on bone density and risk of bone fractures[J]. Medicina，2024，60(3)：393. DOI：10.3390/medicina60030393.
[78]	WU C, KATO T S, PRONSCHINSKE K, et al. Dynamics of bone turnover markers in patients with heart failure and following haemodynamic improvement through ventricular assist device implantation[J]. Eur J Heart Fail，2012，14(12)：1356-1365. DOI：10.1093/eurjhf/hfs138.
[79]	LIU S H, TAN Y M, HUANG W D, et al. Cardiovascular safety of zoledronic acid in the treatment of primary osteoporosis：a meta-analysis and systematic review[J]. Semin Arthritis Rheum，2024，64：152304. DOI：10.1016/j.semarthrit.2023.152304.
[80]	WITTE K K, BYROM R, GIERULA J, et al. Effects of vitamin D on cardiac function in patients with chronic HF：the VINDICATE study[J]. J Am Coll Cardiol，2016，67(22)：2593-2603. DOI：10.1016/j.jacc.2016.03.508.
[81]	COSMAN F, PETERSON L R, TOWLER D A, et al. Cardiovascular safety of abaloparatide in postmenopausal women with osteoporosis：analysis from the ACTIVE phase 3 trial[J]. J Clin Endocrinol Metab，2020，105(11)：3384-3395. DOI：10.1210/clinem/dgaa450.
[82]	ALNAQBI K A, AL ZEYOUDI J, ALJABERI A K. Cardiac arrhythmia and heart failure shortly after starting romosozumab for osteoporosis：a case-based review[J]. Cureus，2023，15(12)：e50303. DOI：10.7759/cureus.50303.
[83]	SHERER J A, HUANG Q X, KIEL D P, et al. Atrial fibrillation and the risk of subsequent fracture[J]. Am J Med，2020，133(8)：954-960. DOI：10.1016/j.amjmed.2020.02.012.
[84]	WONG C X, GAN S W, LEE S W, et al. Atrial fibrillation and risk of hip fracture：a population-based analysis of 113，600 individuals[J]. Int J Cardiol，2017，243：229-232. DOI：10.1016/j.ijcard.2017.05.012.
[85]	LAI H C, CHIEN W C, CHUNG C H, et al. Atrial fibrillation，CHA2DS2-VASc score，antithrombotics and risk of non-traffic-，non-cancer-related bone fractures：a population-based cohort study[J]. Eur J Intern Med，2015，26(10)：798-806. DOI：10.1016/j.ejim.2015.10.002.
[86]	KIM D, YANG P S, KIM T H, et al. Effect of atrial fibrillation on the incidence and outcome of osteoporotic fracture - A nationwide population-based study[J]. Circ J，2018，82(8)：1999-2006. DOI：10.1253/circj.cj-17-1179.
[87]	WALLACE E R, SISCOVICK D S, SITLANI C M, et al. Incident atrial fibrillation and the risk of fracture in the cardiovascular health study[J]. Osteoporos Int，2017，28(2)：719-725. DOI：10.1007/s00198-016-3778-1.
[88]	张韩，李彦明，刘枫，等. 房颤患者左心房内径与血清骨保护素及其受体轴的关系及临床意义[J]. 临床心血管病杂志，2015，31(3)：334-336. DOI：10.13201/j.issn.1001-1439.2015.03.027.
[89]	易懿. 成骨细胞MR在房颤和心房纤维化中的机制研究[D]. 上海：上海交通大学，2018.
[90]	MARQUES J V O, NALEVAIKO J Z, OLIVEIRA M F, et al. Trabecular bone score（TBS）and bone mineral density in patients with long-term therapy with warfarin[J]. Arch Osteoporos，2020，15(1)：102. DOI：10.1007/s11657-020-00770-z.
[91]	SUGIYAMA T, KUGIMIYA F, KONO S, et al. Warfarin use and fracture risk：an evidence-based mechanistic insight[J]. Osteoporos Int，2015，26(3)：1231-1232. DOI：10.1007/s00198-014-2912-1.
[92]	XIE X P, LIU Y M, LI J B, et al. Fracture risks in patients with atrial fibrillation treated with different oral anticoagulants：a meta-analysis and systematic review[J]. Age Ageing，2022，51(1)：afab264. DOI：10.1093/ageing/afab264.
[93]	HUANG H K, PENG C C, LIN S M, et al. Fracture risks in patients treated with different oral anticoagulants：a systematic review and meta-analysis[J]. J Am Heart Assoc，2021，10(7)：e019618. DOI：10.1161/JAHA.120.019618.
[94]	LIU Y M, XIE X P, BI S Q, et al. Risk of osteoporosis in patients treated with direct oral anticoagulants vs. warfarin：an analysis of observational studies[J]. Front Endocrinol，2023，14：1212570. DOI：10.3389/fendo.2023.1212570.
[95]	YANG H Y, HUANG J H, CHIU H W, et al. Vitamin D and bisphosphonates therapies for osteoporosis are associated with different risks of atrial fibrillation in women：a nationwide population-based analysis[J]. Medicine，2018，97(43)：e12947. DOI：10.1097/MD.0000000000012947.
[96]	PARK J H, KO H J. The association between treatment with bisphosphonates and the risk of atrial fibrillation：a meta-analysis of observational studies[J]. Korean J Fam Med，2022，43(1)：69-76. DOI：10.4082/kjfm.21.0110.
[97]	李莉，杨静，张晓君，等. 扩张性心肌病患者骨代谢指标状况及其临床意义[J]. 中国骨质疏松杂志，2021，27(11)：1609-1613. DOI：10.3969/j.issn.1006-7108.2021.11.010.
[98]	TASTET L, SHEN M, CAPOULADE R, et al. Bone mineral density and progression rate of calcific aortic valve stenosis[J]. J Am Coll Cardiol，2020，75(14)：1725-1726. DOI：10.1016/j.jacc.2020.01.053.
[99]	HEKIMIAN G, BOUTTEN A, FLAMANT M, et al. Progression of aortic valve stenosis is associated with bone remodelling and secondary hyperparathyroidism in elderly patients—the COFRASA study[J]. Eur Heart J，2013，34(25)：1915-1922. DOI：10.1093/eurheartj/ehs450.
[100]	AMBALAVANAN J, HUBBARD C, KHAN L Z. Acceleration of preexisting aortic stenosis after teriparatide initiation[J]. AACE Clin Case Rep，2024，10(4)：152-155. DOI：10.1016/j.aace.2024.04.006.
[101]	ALISHIRI G, HESHMAT-GHAHDARIJANI K, HASHEMI M, et al. Alendronate slows down aortic stenosis progression in osteoporotic patients：an observational prospective study[J]. J Res Med Sci，2020，25：65. DOI：10.4103/jrms.jrms_408_20.
[102]	TSURUDA T, FUNAMOTO T, SUZUKI C, et al. Increasing baseline aortic valve peak flow velocity is associated with progression of aortic valve stenosis in osteoporosis patients-a possible link to low vitamin D status[J]. Arch Osteoporos，2023，18(1)：129. DOI：10.1007/s11657-023-01339-2.

分类	高血压	冠心病	慢性心力衰竭	心房颤动	扩心病
增加BMD	噻嗪类利尿剂，β受体阻滞剂，ACEI，ARB，螺内酯	阿托伐他汀，辛伐他汀	β受体阻滞剂，ACEI，ARB，螺内酯	达比加群，利伐沙班，阿哌沙班	β受体阻滞剂，ACEI，ARB，螺内酯
无显著影响			SGLT2i（达格列净、恩格列净）
降低BMD	α受体阻滞剂和袢利尿剂		袢利尿剂，SGLT2i（卡格列净）	华法林	袢利尿剂

分类	高血压	冠心病	慢性心力衰竭	心房颤动	扩心病
增加BMD	噻嗪类利尿剂，β受体阻滞剂，ACEI，ARB，螺内酯	阿托伐他汀，辛伐他汀	β受体阻滞剂，ACEI，ARB，螺内酯	达比加群，利伐沙班，阿哌沙班	β受体阻滞剂，ACEI，ARB，螺内酯
无显著影响			SGLT2i（达格列净、恩格列净）
降低BMD	α受体阻滞剂和袢利尿剂		袢利尿剂，SGLT2i（卡格列净）	华法林	袢利尿剂