Relationship between Bone Mineral Density and Serum Osteoprotegerin in Patients with Chronic Heart Failure

PLOS ONE, Dec 2019

Purpose Heart failure (HF) had been reported with increased risk of hip fractures. However, the relationship between circulating biomarkers and bone mineral density (BMD) in chronic HF remained unclear. Methods This is a cross-sectional study which recruited stable chronic HF from registry of the Heart Failure Center of National Taiwan University Hospital. Patients underwent dual-energy x-ray absorptiometry (DEXA) measurements at hip and lumbar spines and biochemical assessments including B-type natriuretic peptide (BNP-32), myostatin, follistatin and osteoprotegerin (OPG). Results A total of 115 stable chronic HF individuals with left ventricular ejection fraction (EF) <45% (74% of male, mean age at 59) were recruited with 24 patients in NYHA class I, 73 patients in NYHA class II and 18 patients in NYHA class III. Results of BMD showed that Z scores of hip in NYHA III group (−0.12±1.15) was significantly lower than who were NYHA II (0.58±1.04). Serum OPG was significantly higher in subjects of NYHA III (9.3±4.6 pmol/l) than NYHA II (7.4±2.8 pmol/l) or NYHA I (6.8±3.6 pmol/l) groups. There’s a significant negative association between log transformed serum OPG and trochanteric BMD (R = −0.299, P = 0.001), which remained significant after multivariate analysis. Conclusions Our study demonstrated an inverse association between serum OPG and trochanteric BMD in patients with HF. OPG may be a predictor of BMD and an alternative to DEXA for identifying at risk HF patients for osteoporosis.

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Relationship between Bone Mineral Density and Serum Osteoprotegerin in Patients with Chronic Heart Failure

et al. (2012) Relationship between Bone Mineral Density and Serum Osteoprotegerin in Patients with Chronic Heart Failure. PLoS ONE 7(8): e44242. doi:10.1371/journal.pone.0044242 Relationship between Bone Mineral Density and Serum Osteoprotegerin in Patients with Chronic Heart Failure Ying-Hsien Chen 0 Yen-Wen Wu 0 Wei-Shiung Yang 0 Shoei-Shen Wang 0 Chi-Ming Lee 0 Nai- 0 Kuan Chou 0 Ron-Bin Hsu 0 Yen-Hung Lin 0 Mao-Shin Lin 0 Yi-Lwun Ho 0 Ming-Fong Chen 0 Rajesh Mohanraj, UAE University, Faculty of Medicine & Health Sciences, United Arab Emirates 0 1 National Taiwan University College of Medicine , Taipei, Taiwan , 2 Department of Internal Medicine, National Taiwan University Hospital , Taipei, Taiwan , 3 Department of Nuclear Medicine, National Taiwan University Hospital , Taipei, Taiwan , 4 Department of Surgery, National Taiwan University Hospital , Taipei, Taiwan , 5 Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liu City, Taiwan, 6 Department of Nuclear Medicine, Far Eastern Memorial Hospital , New Taipei City , Taiwan Purpose: Heart failure (HF) had been reported with increased risk of hip fractures. However, the relationship between circulating biomarkers and bone mineral density (BMD) in chronic HF remained unclear. PLOS ONE | www.plosone.org - Methods: This is a cross-sectional study which recruited stable chronic HF from registry of the Heart Failure Center of National Taiwan University Hospital. Patients underwent dual-energy x-ray absorptiometry (DEXA) measurements at hip and lumbar spines and biochemical assessments including B-type natriuretic peptide (BNP-32), myostatin, follistatin and osteoprotegerin (OPG). Results: A total of 115 stable chronic HF individuals with left ventricular ejection fraction (EF) ,45% (74% of male, mean age at 59) were recruited with 24 patients in NYHA class I, 73 patients in NYHA class II and 18 patients in NYHA class III. Results of BMD showed that Z scores of hip in NYHA III group (20.1261.15) was significantly lower than who were NYHA II (0.5861.04). Serum OPG was significantly higher in subjects of NYHA III (9.364.6 pmol/l) than NYHA II (7.462.8 pmol/l) or NYHA I (6.863.6 pmol/l) groups. Theres a significant negative association between log transformed serum OPG and trochanteric BMD (R = 20.299, P = 0.001), which remained significant after multivariate analysis. Conclusions: Our study demonstrated an inverse association between serum OPG and trochanteric BMD in patients with HF. OPG may be a predictor of BMD and an alternative to DEXA for identifying at risk HF patients for osteoporosis. Funding: The work was supported by National Science Council of Taiwan [NSC 98-2314-B-002-145-MY2] to YW Wu and [NSC 99-2911-I-008-100] to YL Ho and Department of Health, Executive Yuan, R.O.C. [DOH 99-TD-B-111-001] to YL Ho. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. . These authors contributed equally to this work. Heart failure (HF) and osteoporosis, both as disabling conditions, are two common chronic conditions in elderly which are gaining importance for healthcare recently due to the associated significant morbidity and mortality [1]. These two disabling conditions adversely affect quality of life especially in frail elderly individuals. From recent large epidemiological study, HF is associated with a substantial increase in osteoporotic fractures, particularly in the hip region [2]. In addition to decreased physical performance in HF and sharing a number of common risk factors [3] such as older age, smoking, renal insufficiency and type 2 diabetes, accelerated bone loss may also come from altered vitamin D levels, hyperparathyroidism [4] elevated aldosterone levels [5], elevated fibrotic markers [6] and loop diuretics use in subjects with HF [7]. Cardiac cachexia-related biomarkers including adiponection, follistatin and myostatin had been investigated in muscle, fat, and bone metabolism in heart failure metabolism [8], however, the relationship between circulating biomarkers and bone mineral density (BMD) in chronic HF remained unclear. To the best of our knowledge, HF is a clinical syndrome characterized by prolonged activation of the neuroendocrine system ranging from sympathoadrenal system, natriuretic peptides, renin-angiotensin-aldosterone system (RAAS) and to updated markers of osteoprotegerin (OPG) [9]. The higher OPG level predicts poor prognosis in subjects with HF with higher allcause mortality and hospitalization for worsening of HF [10]. OPG has also been reported to be associated with neuroendocrine activation in elderly males with systolic HF [11] which makes believe that there were interaction among HF and osteoporosis through systemic hormonal activation. However, a direct causal association between these circulating biomarkers and osteoporosis or ris (...truncated)


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Ying-Hsien Chen, Yen-Wen Wu, Wei-Shiung Yang, Shoei-Shen Wang, Chi-Ming Lee, Nai-Kuan Chou, Ron-Bin Hsu, Yen-Hung Lin, Mao-Shin Lin, Yi-Lwun Ho, Ming-Fong Chen. Relationship between Bone Mineral Density and Serum Osteoprotegerin in Patients with Chronic Heart Failure, PLOS ONE, 2012, Volume 7, Issue 8, DOI: 10.1371/journal.pone.0044242