Preprints.org · Nov 5, 2026

Cardiovascular Disease Subtypes and Osteoporosis: Epidemiological Evidence, Biological Mechanisms, and Clinical Perspectives

By Chazanga L, Shi Z, Dhakal R et al.

Cardiovascular diseases (CVD) and osteoporosis pose major clinical challenges for older adults worldwide. Evidence suggests these diseases are interconnected through shared biological mechanisms and risk factors. However, differences in the associations between specific CVD subtypes and osteoporosis remain incompletely understood. We examine osteoporosis in relation to coronary artery disease (CAD) and myocardial infarction (MI), stroke, atrial fibrillation (AF), peripheral arterial disease (PAD), and heart failure (HF). The review considers epidemiological evidence, shared biological mechanisms, medication effects, and questions for future research on cardiovascular–bone interactions. Studies addressing CVD, bone mineral density (BMD), osteoporosis, or fracture outcomes were identified through PubMed and backward citation searching.Across these cardiovascular conditions, studies report associations with low BMD, osteoporosis, or hip fracture. Their magnitude and consistency vary, however, according to the CVD subtype, study population, and skeletal outcome. Proposed links include chronic inflammation, oxidative stress, vascular calcification, endocrine dysregulation, and changes in RANK/RANKL/OPG and Wnt/β-catenin signaling. Genomic approach, large population-based cohorts, and causal inference methods offer opportunities to improve understanding of the complex cardiovascular-bone interactions. Further research is needed to classify subtype-specific associations and mechanisms, assess potential causal relationships, and determine whether these insights can improve risk prediction, prevention, early detection, and management of CVDs, osteoporosis, and osteoporotic hip fractures.

doi.org/10.20944/preprints202609.0518.v2Open accessMechanisms