血管石灰化とビスホスホネート

Vascular Calcification～Pathological Mechanism and Clinical Application～. Bisphosphonates for vascular calcification.

　本邦では高齢化に伴い，糖尿病や慢性腎臓病患者数が増加の一途を辿っている。糖尿病や慢性腎臓病患者ではしばしば血管石灰化を併発し，これらは生命予後に大きな影響を与えるものの，根本的な治療は進んでいない。近年，血管石灰化の病態形成機構が解明され，骨の石灰化過程との類似性が明確にされてきた。その結果，治療法が未確立の血管石灰化に対して，骨吸収阻害薬であるビスホスホネート（BPs）の有用性が注目されている。本稿では，血管石灰化への治療薬としてのBPsの可能性について，当科における知見も加えて概説する。

　In Japan, the number of diabetes mellitus and chronic kidney disease patients is increasing yearly. Vascular calcification is prevailing in patients suffering from diabetes mellitus and/or chronic kidney disease, and carries a poor prognosis. However, the effective treatment for suppressing the progression of vascular calcification has not been established. On the other hand, treatment of osteoporosis has advanced dramatically as the details of the mechanism become clearer. Bisphosphonates, which are inhibitors of bone resorption that are widely used to treat osteoporosis, also inhibit cholesterol biosynthesis, differentiation of macrophage to foam cell, differentiation of smooth muscle cells to osteoblast-like cells in certain stimuli during calcification processes of vessels. These findings extend the link between bone remodeling and vascular calcification, opening perspectives toward novel therapeutic strategies. We herein review recent findings about effectiveness of bisphosphonates for vascular calcification with our data. Here we will review recent advances in the researches of treatment of vascular calcification and present our findings that the bisphosphonate is useful in prevention of vascular calcification.