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
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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)