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Updated: Jun 14, 2025
Calcification of Vascular Smooth Muscle Cells and Imaging of Aortic Calcification and Inflammation
Published on: May 31, 2016
Effect of osteoporosis medications on vascular and valvular calcification: a systematic review and meta-analysis
Hui Zhen Lo1, Kevin Leow2, Rachael Hii3
1Peninsula Health, 2 Hastings Road, Frankston, VIC, 3199, Australia.
Insights
Anti-resorptive medications, used to reduce bone loss, show a small, uncertain benefit in reducing aortic valve calcification. These drugs do not significantly impact vascular calcification, suggesting osteoporosis and vascular calcification pathways are not fully linked by these treatments.
Area of Science:
- Cardiovascular Medicine
- Bone Metabolism
- Pharmacology
Background:
- Vascular calcification shares similarities with skeletal mineralization but has an inverse relationship with osteoporosis.
- Medications reducing bone loss (anti-resorptives) have shown inconsistent effects on vascular and valvular calcification.
Purpose of the Study:
- To synthesize existing literature on the effects of anti-resorptive treatments on extra-skeletal (vascular and valvular) calcification.
- To evaluate the association between anti-resorptive medication use and calcification in the vasculature and heart valves.
Main Methods:
- Searched Medline and Embase databases from inception to October 2024 for relevant studies.
- Conducted a meta-analysis of 15 studies (2344 participants) using random-effects models to calculate pooled standardized mean differences (SMDs).
- Performed leave-one-out sensitivity analyses to assess the internal validity of the findings.
Main Results:
- Anti-resorptive use was associated with non-significant, small improvements in abdominal aortic calcification and coronary artery calcification.
- A significant small reduction in aortic valve area (indicating less calcification) was observed (SMD -0.45, 95% CI -0.99 to 0.08).
- Ejection fraction showed a small increase (SMD 0.26, 95% CI -0.14 to 0.66).
Conclusions:
- Anti-resorptive medications demonstrate a small, positive effect on aortic stenosis, but its clinical significance remains uncertain.
- Despite biological links, anti-resorptives do not appear to strongly influence extra-skeletal mineralization, suggesting distinct underlying pathways.
- Further research is needed to elucidate the mechanisms linking vascular calcification and osteoporosis that are independent of anti-resorptive drug action.
Objective:
Vascular calcification shares many features with skeletal mineralisation and shares an inverse relationship with osteoporosis (skeletal de-mineralisation). However, medications that reduce bone loss (anti-resorptives) have had inconsistent effects on extra-skeletal mineralisation (i.e. vascular and valvular calcification). As such, this paper aims to synthesise existing literature examining the effect of anti-resorptive treatments on extra-skeletal (vascular and valvular) calcification across populations.
Methods:
Medline and Embase were searched (inception to October 2024) for studies that assessed the association between anti-resorptive medication use and vascular/valvular calcification. Pooled standardised mean differences (SMDs) with 95% confidence intervals (CI) were calculated for all outcomes, using random-effects model. Leave-one-out sensitivity analyses were performed for internal validity.
Results:
Of 4071 articles screened, 33 were included in the review, and 15 (2344 participants) had data available for meta-analysis. Anti-resorptive use was associated with non-significant, small magnitude improvements in abdominal aortic calcification (decreased value), coronary artery calcification (decreased value) and ejection fraction (increased value) but significant small reduction in aortic valve area (representing less calcification on the valve) with standardised mean difference of - 0.45 (95% confidence interval (CI) - 0.99; 0.08, I2 = 84%), - 1.19 (95% CI - 2.92; 0.55, I2 = 91%), - 0.67 (95% CI - 1.72; 0.38, I2 = 94%), 0.26 (95% CI - 0.14; 0.66, I2 = 62%) and 0.56 (95% CI 0.07; 1.06, I2 = 76%), respectively.
Conclusion:
The significance of small positive effect of anti-resorptives on aortic stenosis is clinically uncertain. Despite strong biological links between vascular calcification and skeletal mineralisation, anti-resorptives do not appear to have a strong favourable influence on extra-skeletal mineralisation. This suggests that mechanisms that link vascular calcification with osteoporosis may be acting in pathways not influenced by anti-resorptives. This systematic review and meta-analysis summarises the effect of anti-resorptives on vascular and valvular calcification. There is a small, positive effect of anti-resorptives on aortic stenosis, though this is of uncertain clinical importance.
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