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Abstract：
BACKGROUND: Patients with COPD are often affected by loss of bone mineral density (BMD) and osteoporotic fractures. Natriuretic peptides (NP) are known as cardiac markers, but have also been linked to fragility-associated fractures in the elderly. As their functions include regulation of fluid and mineral balance, they also might affect bone metabolism, particularly in systemic disorders such as COPD.
OBJECTIVE: We investigated the association between NP serum levels, vertebral fractures and BMD assessed by chest computed tomography (CT) in patients with COPD.
METHODS: Participants of the COSYCONET cohort with CT scans were included. Mean vertebral bone density on CT (BMD-CT) as a risk factor for osteoporosis was assessed at the level of TH12 (AI-Rad Companion), and vertebral compression fractures were visually quantified by two readers. Their relationship with N-terminal pro-B-type natriuretic peptide (NT-proBNP), Mid-regional pro-atrial natriuretic peptide (MRproANP) and Midregional pro-adrenomedullin (MRproADM) was determined using group comparisons and multivariable analyses.
RESULTS: Among 418 participants (58% male, median age 64 years, FEV1 59.6% predicted), vertebral fractures in TH12 were found in 76 patients (18.1%). Compared to patients without fractures, these had elevated serum levels (p ≤ 0.005) of MRproANP and MRproADM. Using optimal cut-off values in multiple logistic regression analyses, MRproANP levels ≥ 65 nmol/l (OR 2.34; p = 0.011) and age (p = 0.009) were the only significant predictors of fractures after adjustment for sex, BMI, smoking status, FEV1% predicted, SGRQ Activity score, daily physical activity, oral corticosteroids, the diagnosis of cardiac disease, and renal impairment. Correspondingly, MRproANP (p < 0.001), age (p = 0.055), SGRQ Activity score (p = 0.061) and active smoking (p = 0.025) were associated with TH12 vertebral density.
CONCLUSIONS: MRproANP was a marker for osteoporotic vertebral fractures in our COPD patients from the COSYCONET cohort. Its association with reduced vertebral BMD on CT and its known modulating effects on fluid and ion balance are suggestive of direct effects on bone mineralization.
BACKGROUND: ClinicalTrials.gov NCT01245933, Date of registration: 18 November 2010.
OBJECTIVE: We investigated the association between NP serum levels, vertebral fractures and BMD assessed by chest computed tomography (CT) in patients with COPD.
METHODS: Participants of the COSYCONET cohort with CT scans were included. Mean vertebral bone density on CT (BMD-CT) as a risk factor for osteoporosis was assessed at the level of TH12 (AI-Rad Companion), and vertebral compression fractures were visually quantified by two readers. Their relationship with N-terminal pro-B-type natriuretic peptide (NT-proBNP), Mid-regional pro-atrial natriuretic peptide (MRproANP) and Midregional pro-adrenomedullin (MRproADM) was determined using group comparisons and multivariable analyses.
RESULTS: Among 418 participants (58% male, median age 64 years, FEV1 59.6% predicted), vertebral fractures in TH12 were found in 76 patients (18.1%). Compared to patients without fractures, these had elevated serum levels (p ≤ 0.005) of MRproANP and MRproADM. Using optimal cut-off values in multiple logistic regression analyses, MRproANP levels ≥ 65 nmol/l (OR 2.34; p = 0.011) and age (p = 0.009) were the only significant predictors of fractures after adjustment for sex, BMI, smoking status, FEV1% predicted, SGRQ Activity score, daily physical activity, oral corticosteroids, the diagnosis of cardiac disease, and renal impairment. Correspondingly, MRproANP (p < 0.001), age (p = 0.055), SGRQ Activity score (p = 0.061) and active smoking (p = 0.025) were associated with TH12 vertebral density.
CONCLUSIONS: MRproANP was a marker for osteoporotic vertebral fractures in our COPD patients from the COSYCONET cohort. Its association with reduced vertebral BMD on CT and its known modulating effects on fluid and ion balance are suggestive of direct effects on bone mineralization.
BACKGROUND: ClinicalTrials.gov NCT01245933, Date of registration: 18 November 2010.
摘要：
背景：COPD患者常受到骨密度（BMD）丢失和骨质疏松性骨折的影响。利钠肽（NP）被称为心脏标志物，但也与老年人的脆性相关骨折有关。由于它们的功能包括调节流体和矿物质平衡，它们还可能影响骨骼代谢，特别是在全身性疾病如COPD中。
目的：我们研究了NP血清水平之间的关联，通过胸部计算机断层扫描（CT）评估COPD患者的椎体骨折和BMD。
方法：纳入有CT扫描的COSYCONET队列的参与者。在TH12（AI-RadCompanion）水平上评估作为骨质疏松症危险因素的CT平均椎骨密度（BMD-CT），两名读者对椎体压缩性骨折进行了视觉量化。它们与N末端B型利钠肽原（NT-proBNP）的关系，使用组比较和多变量分析确定了中部区域前心房利钠肽（MRproANP）和中部区域前肾上腺髓质素（MRproADM）。
结果：在418名参与者中（58％为男性，中位年龄64岁，FEV159.6%预测)，76例(18.1%)患者发现TH12椎体骨折。与没有骨折的患者相比，这些患者的血清MRproANP和MRproADM水平升高(p≤0.005).在多元逻辑回归分析中使用最佳临界值，MRproANP水平≥65nmol/l（OR2.34;p=0.011）和年龄（p=0.009）是性别调整后骨折的唯一重要预测因素，BMI,吸烟状况,FEV1%预测，SGRQ活动得分,日常体力活动,口服皮质类固醇,心脏病的诊断,和肾功能损害。相应地,MRproANP（p<0.001），年龄（p=0.055），SGRQ活动评分(p=0.061)和主动吸烟(p=0.025)与TH12椎体密度相关。
结论：MRproANP是COSYCONET队列中COPD患者骨质疏松性椎体骨折的标志物。其与CT上降低的椎骨BMD的关联及其对流体和离子平衡的已知调节作用提示对骨矿化的直接影响。
背景：ClinicalTrials.govNCT01245933，注册日期：2010年11月18日。
目的：我们研究了NP血清水平之间的关联，通过胸部计算机断层扫描（CT）评估COPD患者的椎体骨折和BMD。
方法：纳入有CT扫描的COSYCONET队列的参与者。在TH12（AI-RadCompanion）水平上评估作为骨质疏松症危险因素的CT平均椎骨密度（BMD-CT），两名读者对椎体压缩性骨折进行了视觉量化。它们与N末端B型利钠肽原（NT-proBNP）的关系，使用组比较和多变量分析确定了中部区域前心房利钠肽（MRproANP）和中部区域前肾上腺髓质素（MRproADM）。
结果：在418名参与者中（58％为男性，中位年龄64岁，FEV159.6%预测)，76例(18.1%)患者发现TH12椎体骨折。与没有骨折的患者相比，这些患者的血清MRproANP和MRproADM水平升高(p≤0.005).在多元逻辑回归分析中使用最佳临界值，MRproANP水平≥65nmol/l（OR2.34;p=0.011）和年龄（p=0.009）是性别调整后骨折的唯一重要预测因素，BMI,吸烟状况,FEV1%预测，SGRQ活动得分,日常体力活动,口服皮质类固醇,心脏病的诊断,和肾功能损害。相应地,MRproANP（p<0.001），年龄（p=0.055），SGRQ活动评分(p=0.061)和主动吸烟(p=0.025)与TH12椎体密度相关。
结论：MRproANP是COSYCONET队列中COPD患者骨质疏松性椎体骨折的标志物。其与CT上降低的椎骨BMD的关联及其对流体和离子平衡的已知调节作用提示对骨矿化的直接影响。
背景：ClinicalTrials.govNCT01245933，注册日期：2010年11月18日。
