| Osteoporosis and vascular calcification are two important diseases threatening the health of middle-aged and elderly people. They have been generally considered to be independently related to aging. However, emerging clinical and basic studies have indicated that they are closely related and may share common risk factors. Also, they may be regulated by the same pathways, proteins, and hormones, including RANKL-RANK-OPG pathway, Wnt signaling pathway, and parathyroid hormone, etc. Sclerostin, a Wnt signaling pathway inhibitor, plays a key role not only in bone remodeling, but also in vascular calcification. Studies have found that, when vascular calcification occurs, vascular smooth muscle cells undergo osteoid cell trans-differentiation and secrete sclerostin. However, whether sclerostin is protective or detrimental in the calcification of blood vessels remains controversial. Recent clinical studies have shown that, a sclerostin antibody (romosozumab), which targets the Wnt pathway and is used to treat osteoporosis, has dual effects on promoting bone formation and inhibiting bone resorption. Its therapeutic effect is better than other anti-osteoporosis drugs. However, phase III clinical trials have shown that it can increase the risk of cardiovascular diseases. The underlying mechanism remains unclear and requires further research. In summary, investigating the relationship between osteoporosis and vascular calcification and their common mechanism is of great significance to avoid the side effects of a specific drug and to prevent and treat both diseases at the same time. |