Osteoporosis and cardiovascular disease: lessons from chronic kidney disease.

Osteoporosis is a common complication of chronic kidney disease (CKD), and the latter is a major risk factor for cardiovascular mortality. Recent studies have elucidated some of the mechanisms by which CKD is a cardiovascular risk, and they relate to osteoporosis. Thus, the mechanisms of CKD induced cardiovascular risk provide valuable insight into the relationship between cardiovascular disease and osteoporosis, and they are reviewed here. Observational studies have determined hyperphosphatemia to be a cardiovascular risk factor in chronic kidney disease. Mechanistic studies have elucidated that hyperphosphatemia is a direct stimulus to vascular calcification, which is one cause of morbid cardiovascular events contributing to the excess mortality of chronic kidney disease. Hyperphosphatemia in chronic kidney is due to failure of excretion by the kidneys and excess bone resorption. It stimulates vascular cells to mineralize atherosclerotic plaques through osteoblastic processes. Hyperphosphatemia in chronic kidney disease is a distinct syndrome characterized by disordered skeletal remodeling, heterotopic mineralization and cardiovascular morbidity. The heterotopic mineralization stimulated by CKD is relevant to osteoporosis.