New approaches to the prediction of combined bone and cardiovascular pathology

Atherosclerotic cardiovascular diseases (ASCVD) and osteoporosis have a high degree of comorbidity, which mutually exacerbates their severity and increases the risk of complications. Common pathogenetic mechanisms and risk factors for these diseases have been identified. This review summarizes and summarizes data from domestic and international studies confirming the comorbidity of ASCVD and osteoporosis based on identified associations between preclinical parameters, such as bone mineral density (BMD), vascular stiffness parameters (pulse wave velocity, augmentation index), and preclinical atherosclerosis (atherosclerotic plaques and coronary artery calcification). Furthermore, associations between the diseases at the risk level and the often asymptomatic course of the diseases at onset prompted the authors to seek novel preclinical methods for diagnosing and predicting the comorbidity to implement timely treatment and preventive measures. Based on a cross-sectional study demonstrating the independent contribution of carotid plaques and elevated calcium levels to decreased BMD in postmenopausal patients, a diagnostic algorithm has been developed to assess the preclinical risk of ASCVD and osteoporosis and their complications. The results of a prospective study, which confirmed the maintenance of a stable negative association between vascular stiffness parameters, preclinical atherosclerosis, and BMD over 10 years, have led to the development of a method for osteopenia prediction using preclinical markers of atherosclerosis. The proposed methods enable timely risk prediction, diagnosis of comorbidities, and initiation of treatment and preventive measures at various levels of healthcare delivery (outpatient and inpatient), particularly in primary care.