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Wei R, Zhang Y, Huang M, Piao H, Gu Z, Zhu C. Associations between bone mineral density and abdominal aortic calcification: Results of a nationwide survey. Nutr Metab Cardiovasc Dis 2024; 34:1488-1495. [PMID: 38494366 DOI: 10.1016/j.numecd.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/21/2023] [Accepted: 01/29/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND AND AIMS Vascular calcification has been linked to bone mineral density (BMD). This study aimed to investigate the association between BMD and abdominal aortic calcification (AAC). METHODS AND RESULTS Data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) were utilized. Participants lacking BMD and AAC score data were excluded. BMD at the femoral neck was measured using dual-energy X-ray absorptiometry. AAC scores were assessed using the Kauppila scoring system, with AAC defined as a score greater than zero, and severe AAC defined as a score greater than six. Weighted multivariable regression analysis and subgroup analysis were conducted to examine the independent relationship between BMD and AAC score, AAC, and severe AAC. A total of 2965 participants were included. After adjusting for multiple covariates, BMD showed a negative association with higher AAC scores (β = -0.17, 95% CI -0.29, -0.05, p = 0.0066). The odds of having AAC and severe AAC decreased by 9% and 16%, respectively, for every one-unit increase in BMD (AAC: odds ratio [OR] = 0.91, 95% CI 0.82, 1.00, p = 0.0431; severe AAC: OR = 0.84, 95% CI 0.71, 0.99, p = 0.0334). CONCLUSION Low BMD is associated with higher AAC scores and an increased risk of AAC and severe AAC. Considering the detrimental impact of low BMD on cardiovascular health, individuals with AAC should be evaluated for osteopenia and osteoporosis in clinical settings.
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Affiliation(s)
- Ran Wei
- Cardiovascular Surgery Department of the Second Hospital of Jilin University, Jilin Province, China
| | - Yixin Zhang
- Cardiovascular Surgery Department of the Second Hospital of Jilin University, Jilin Province, China
| | - Maoxun Huang
- Cardiovascular Surgery Department of the Second Hospital of Jilin University, Jilin Province, China
| | - Hulin Piao
- Cardiovascular Surgery Department of the Second Hospital of Jilin University, Jilin Province, China
| | - Zhaoxuan Gu
- Cardiovascular Surgery Department of the Second Hospital of Jilin University, Jilin Province, China
| | - Cuilin Zhu
- Cardiovascular Surgery Department of the Second Hospital of Jilin University, Jilin Province, China.
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Zheng J, He J, Li H. FAM19A5 in vascular aging and osteoporosis: Mechanisms and the "calcification paradox". Ageing Res Rev 2024; 99:102361. [PMID: 38821416 DOI: 10.1016/j.arr.2024.102361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/05/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
Aging induces a progressive decline in the vasculature's structure and function. Vascular aging is a determinant factor for vascular ailments in the elderly. FAM19A5, a recently identified adipokine, has demonstrated involvement in multiple vascular aging-related pathologies, including atherosclerosis, cardio-cerebral vascular diseases and cognitive deficits. This review summarizes the current understanding of FAM19A5' role and explores its putative regulatory mechanisms in various aging-related disorders, including cardiovascular diseases (CVDs), metabolic diseases, neurodegenerative diseases and malignancies. Importantly, we provide novel insights into the underlying therapeutic value of FAM19A5 in osteoporosis. Finally, we outline future perspectives on the diagnostic and therapeutic potential of FAM19A5 in vascular aging-related diseases.
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Affiliation(s)
- Jin Zheng
- Department of Geriatrics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Jieyu He
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Huahua Li
- Department of Geriatrics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China.
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3
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Smith C, Sim M, Dalla Via J, Gebre AK, Zhu K, Lim WH, Teh R, Kiel DP, Schousboe JT, Levinger I, von Haehling S, Woodman R, Coats AJS, Prince RL, Lewis JR. Extent of Abdominal Aortic Calcification Is Associated With Incident Rapid Weight Loss Over 5 Years: The Perth Longitudinal Study of Ageing Women. Arterioscler Thromb Vasc Biol 2024; 44:e54-e64. [PMID: 38095109 PMCID: PMC10832333 DOI: 10.1161/atvbaha.123.320118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/27/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Abdominal aortic calcification (AAC), a marker of vascular disease, is associated with disease in other vascular beds including gastrointestinal arteries. We investigated whether AAC is related to rapid weight loss over 5 years and whether rapid weight loss is associated with 9.5-year all-cause mortality in community-dwelling older women. METHODS Lateral spine images from dual-energy x-ray absorptiometry (1998/1999) were used to assess AAC (24-point AAC scoring method) in 929 older women. Over 5 years, body weight was assessed at 12-month intervals. Rapid weight loss was defined as >5% decrease in body weight within any 12-month interval. Multivariable-adjusted logistic regression was used to assess AAC and rapid weight loss and Cox regression to assess the relationship between rapid weight loss and 9.5-year all-cause mortality. RESULTS Mean±SD age of women was 75.0±2.6 years. During the initial 5 years, 366 (39%) women presented with rapid weight loss. Compared with women with low AAC (24-point AAC score 0-1), those with moderate (24-point AAC score 2-5: odds ratio, 1.36 [95% CI, 1.00-1.85]) and extensive (24-point AAC score 6+: odds ratio, 1.59 [95% CI, 1.10-2.31]) AAC had higher odds for presenting with rapid weight loss. Results remained similar after further adjustment for dietary factors (alcohol, protein, fat, and carbohydrates), diet quality, blood pressure, and cholesterol measures. The estimates were similar in subgroups of women who met protein intake (n=599) and physical activity (n=735) recommendations (extensive AAC: odds ratios, 1.81 [95% CI, 1.12-2.92] and 1.58 [95% CI, 1.02-2.44], respectively). Rapid weight loss was associated with all-cause mortality over the next 9.5 years (hazard ratio, 1.49 [95% CI, 1.17-1.89]; P=0.001). CONCLUSIONS AAC extent was associated with greater risk for rapid weight loss over 5 years in older women, a risk for all-cause mortality. Since the association was unchanged after taking nutritional intakes into account, these data support the possibility that vascular disease may play a role in the maintenance of body weight.
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Affiliation(s)
- Cassandra Smith
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia (C.S., M.S., J.D.V., A.K.G., J.R.L.)
- Medical School, The University of Western Australia, Perth (C.S., M.S., K.Z., W.H.L., R.T., R.L.P., J.R.L.)
| | - Marc Sim
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia (C.S., M.S., J.D.V., A.K.G., J.R.L.)
- Medical School, The University of Western Australia, Perth (C.S., M.S., K.Z., W.H.L., R.T., R.L.P., J.R.L.)
- Royal Perth Hospital Research Foundation, Western Australia (M.S.)
| | - Jack Dalla Via
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia (C.S., M.S., J.D.V., A.K.G., J.R.L.)
| | - Abadi K Gebre
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia (C.S., M.S., J.D.V., A.K.G., J.R.L.)
| | - Kun Zhu
- Medical School, The University of Western Australia, Perth (C.S., M.S., K.Z., W.H.L., R.T., R.L.P., J.R.L.)
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia (K.Z., R.L.P.)
| | - Wai H Lim
- Medical School, The University of Western Australia, Perth (C.S., M.S., K.Z., W.H.L., R.T., R.L.P., J.R.L.)
- Renal Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia (W.H.L.)
| | - Ryan Teh
- Medical School, The University of Western Australia, Perth (C.S., M.S., K.Z., W.H.L., R.T., R.L.P., J.R.L.)
- Fiona Stanley Hospital, Murdoch, Western Australia (R.T.)
| | - Douglas P Kiel
- Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.P.K.)
| | - John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, Minneapolis, MN (J.T.S.)
- Division of Health Policy and Management, University of Minnesota, Minneapolis (J.T.S.)
| | - Itamar Levinger
- Institute for Health and Sport, Victoria University, Melbourne, Australia (I.L.)
- Australian Institute for Musculoskeletal Science, University of Melbourne and Western Health, St Albans (I.L.)
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Germany (S.v.H.)
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.v.H.)
| | - Richard Woodman
- Flinders Health and Medical Research Institute-Cancer Program, Flinders University, Bedford Park, South Australia (R.W.)
| | | | - Richard L Prince
- Medical School, The University of Western Australia, Perth (C.S., M.S., K.Z., W.H.L., R.T., R.L.P., J.R.L.)
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia (K.Z., R.L.P.)
| | - Joshua R Lewis
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia (C.S., M.S., J.D.V., A.K.G., J.R.L.)
- Medical School, The University of Western Australia, Perth (C.S., M.S., K.Z., W.H.L., R.T., R.L.P., J.R.L.)
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Australia (J.R.L.)
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4
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Szulc P, Lewis JR, Chapurlat R. Accelerated Bone Loss in Older Men With Severe Abdominal Aortic Calcification-the Prospective MINOS Study. J Clin Endocrinol Metab 2023; 109:e32-e39. [PMID: 37610245 DOI: 10.1210/clinem/dgad459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/30/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
CONTEXT Data on the association between the severity of abdominal aortic calcification (AAC) and bone loss are discordant. OBJECTIVE Our aim was to assess the association between baseline AAC and prospectively assessed bone loss in older men. METHODS This prospective cohort study started in 1995 (MINOS). Men aged 50 to 85 years (n = 778) had AAC assessed on the lateral radiograph of the spine using Kauppila's semiquantitative score and was followed prospectively for 7.5 years. Bone mineral density (BMD) and bone mineral content (BMC) were measured by dual-energy x-ray absorptiometry every 18 months. Statistical analysis was performed using linear mixed models. RESULTS In comparison to men without AAC (AAC = 0), severe AAC (>6) was associated with more rapid bone loss at the total hip (-0.62 ± 0.06 vs -0.32 ± 0.04%/year; P < .001), trochanter, and distal forearm (-0.72 ± 0.06 vs -0.45 ± 0.03%/year; P < .001). The highest decile (AAC >10) was associated with more rapid bone loss at the femoral neck, whole body, and ultradistal radius (-0.86 ± 0.12 vs -0.34 ± 0.05%/year; P < .001). The results were similar for BMD and for BMC. The patterns were similar in sensitivity analyses (eg, after excluding men with abdominal obesity, after excluding current smokers, after excluding men with ischemic heart disease or with diabetes mellitus, after excluding men with abnormal concentrations of lipids, bioavailable 17β-estradiol or 25-hydroxycholecalciferol, after excluding men with glomerular filtration rate <60 mL/min). CONCLUSION Severe AAC is associated with faster bone loss in older men and may contribute to the higher fracture risk observed in this population.
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Affiliation(s)
- Pawel Szulc
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, 69437, Lyon, France
| | - Joshua R Lewis
- Institute for Nutrition Research, Edith Cowan University, Joondalup, Perth, WA 6027, Australia
- Medical School, the University of Western Australia, Perth, WA 6009, Australia
| | - Roland Chapurlat
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, 69437, Lyon, France
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5
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Via JD, Gebre AK, Smith C, Gilani Z, Suter D, Sharif N, Szulc P, Schousboe JT, Kiel DP, Zhu K, Leslie WD, Prince RL, Lewis JR, Sim M. Machine-Learning Assessed Abdominal Aortic Calcification is Associated with Long-Term Fall and Fracture Risk in Community-Dwelling Older Australian Women. J Bone Miner Res 2023; 38:1867-1876. [PMID: 37823606 PMCID: PMC10842308 DOI: 10.1002/jbmr.4921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/14/2023] [Accepted: 10/10/2023] [Indexed: 10/13/2023]
Abstract
Abdominal aortic calcification (AAC), a recognized measure of advanced vascular disease, is associated with higher cardiovascular risk and poorer long-term prognosis. AAC can be assessed on dual-energy X-ray absorptiometry (DXA)-derived lateral spine images used for vertebral fracture assessment at the time of bone density screening using a validated 24-point scoring method (AAC-24). Previous studies have identified robust associations between AAC-24 score, incident falls, and fractures. However, a major limitation of manual AAC assessment is that it requires a trained expert. Hence, we have developed an automated machine-learning algorithm for assessing AAC-24 scores (ML-AAC24). In this prospective study, we evaluated the association between ML-AAC24 and long-term incident falls and fractures in 1023 community-dwelling older women (mean age, 75 ± 3 years) from the Perth Longitudinal Study of Ageing Women. Over 10 years of follow-up, 253 (24.7%) women experienced a clinical fracture identified via self-report every 4-6 months and verified by X-ray, and 169 (16.5%) women had a fracture hospitalization identified from linked hospital discharge data. Over 14.5 years, 393 (38.4%) women experienced an injurious fall requiring hospitalization identified from linked hospital discharge data. After adjusting for baseline fracture risk, women with moderate to extensive AAC (ML-AAC24 ≥ 2) had a greater risk of clinical fractures (hazard ratio [HR] 1.42; 95% confidence interval [CI], 1.10-1.85) and fall-related hospitalization (HR 1.35; 95% CI, 1.09-1.66), compared to those with low AAC (ML-AAC24 ≤ 1). Similar to manually assessed AAC-24, ML-AAC24 was not associated with fracture hospitalizations. The relative hazard estimates obtained using machine learning were similar to those using manually assessed AAC-24 scores. In conclusion, this novel automated method for assessing AAC, that can be easily and seamlessly captured at the time of bone density testing, has robust associations with long-term incident clinical fractures and injurious falls. However, the performance of the ML-AAC24 algorithm needs to be verified in independent cohorts. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Jack Dalla Via
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Abadi K Gebre
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray
| | - Cassandra Smith
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Zulqarnain Gilani
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Artificial Intelligence and Machine Learning, School of Science, Edith Cowan University, Perth, Western Australia, Australia
| | - David Suter
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Artificial Intelligence and Machine Learning, School of Science, Edith Cowan University, Perth, Western Australia, Australia
| | - Naeha Sharif
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Artificial Intelligence and Machine Learning, School of Science, Edith Cowan University, Perth, Western Australia, Australia
- Department of Computer Science and Software Engineering, the University of Western Australia, Perth, Western Australia, Australia
| | - Pawel Szulc
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, Lyon, France
| | - John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners, Minneapolis, USA and Division of Health Policy and Management, University of Minnesota, Minneapolis, USA
| | - Douglas P Kiel
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kun Zhu
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - William D. Leslie
- Departments of Medicine and Radiology, University of Manitoba, Winnipeg, Canada
| | - Richard L Prince
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Joshua R Lewis
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Marc Sim
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
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Zhang YR, Liu SM, Chen Y, Zhang LS, Ji DR, Zhao J, Yu YR, Jia MZ, Tang CS, Huang W, Zhou YB, Chai SB, Qi YF. Intermedin alleviates diabetic vascular calcification by inhibiting GLUT1 through activation of the cAMP/PKA signaling pathway. Atherosclerosis 2023; 385:117342. [PMID: 37879153 DOI: 10.1016/j.atherosclerosis.2023.117342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/21/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND AND AIMS Vascular calcification (VC) is regarded as an independent risk factor for cardiovascular events in type 2 diabetic patients. Glucose transporter 1 (GLUT1) involves VC. Intermedin/Adrenomedullin-2 (IMD/ADM2) is a cardiovascular protective peptide that can inhibit multiple disease-associated VC. However, the role and mechanism of IMD in diabetic VC remain unclear. Here, we investigated whether IMD inhibits diabetic VC by inhibiting GLUT1. METHODS AND RESULTS It was found that plasma IMD concentration was significantly decreased in type 2 diabetic patients and in fructose-induced diabetic rats compared with that in controls. Plasma IMD content was inversely correlated with fasting blood glucose level and VC severity. IMD alleviated VC in fructose-induced diabetic rats. Deficiency of Adm2 aggravated and Adm2 overexpression attenuated VC in high-fat diet-induced diabetic mice. In vitro, IMD mitigated high glucose-induced calcification of vascular smooth muscle cells (VSMCs). Mechanistically, IMD reduced advanced glycation end products (AGEs) content and the level of receptor for AGEs (RAGE). IMD decreased glucose transporter 1 (GLUT1) levels. The inhibitory effect of IMD on RAGE protein level was blocked by GLUT1 knockdown. GLUT1 knockdown abolished the effect of IMD on alleviating VSMC calcification. IMD receptor antagonist IMD17-47 and cyclic adenosine monophosphate/protein kinase A (cAMP/PKA) inhibitor H89 abolished the inhibitory effects of IMD on GLUT1 and VSMC calcification. CONCLUSIONS These findings revealed that IMD exerted its anti-calcification effect by inhibiting GLUT1, providing a novel therapeutic target for diabetic VC.
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Affiliation(s)
- Ya-Rong Zhang
- Laboratory of Cardiovascular Bioactive Molecule, School of Basic Medical Sciences, Peking University, Beijing, 100083, China; StateKey Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, 100083, China; Department of Pathogen Biology, School of Basic Medical Science, Peking University, Beijing, 100083, China
| | - Shi-Meng Liu
- Laboratory of Cardiovascular Bioactive Molecule, School of Basic Medical Sciences, Peking University, Beijing, 100083, China; StateKey Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, 100083, China; Department of Pathogen Biology, School of Basic Medical Science, Peking University, Beijing, 100083, China
| | - Yao Chen
- Laboratory of Cardiovascular Bioactive Molecule, School of Basic Medical Sciences, Peking University, Beijing, 100083, China; StateKey Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, 100083, China; Department of Pathogen Biology, School of Basic Medical Science, Peking University, Beijing, 100083, China
| | - Lin-Shuang Zhang
- Laboratory of Cardiovascular Bioactive Molecule, School of Basic Medical Sciences, Peking University, Beijing, 100083, China; StateKey Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, 100083, China; Department of Pathogen Biology, School of Basic Medical Science, Peking University, Beijing, 100083, China
| | - Deng-Ren Ji
- Laboratory of Cardiovascular Bioactive Molecule, School of Basic Medical Sciences, Peking University, Beijing, 100083, China; StateKey Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, 100083, China; Department of Pathogen Biology, School of Basic Medical Science, Peking University, Beijing, 100083, China
| | - Jie Zhao
- Laboratory of Cardiovascular Bioactive Molecule, School of Basic Medical Sciences, Peking University, Beijing, 100083, China; StateKey Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, 100083, China; Department of Pathogen Biology, School of Basic Medical Science, Peking University, Beijing, 100083, China
| | - Yan-Rong Yu
- Department of Pathogen Biology, School of Basic Medical Science, Peking University, Beijing, 100083, China
| | - Mo-Zhi Jia
- Department of Pathogen Biology, School of Basic Medical Science, Peking University, Beijing, 100083, China
| | - Chao-Shu Tang
- StateKey Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, 100083, China
| | - Wei Huang
- StateKey Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, 100083, China
| | - Ye-Bo Zhou
- Department of Physiology, Nanjing Medical University, Nanjing, 211166, China.
| | - San-Bao Chai
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China.
| | - Yong-Fen Qi
- Laboratory of Cardiovascular Bioactive Molecule, School of Basic Medical Sciences, Peking University, Beijing, 100083, China; StateKey Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, 100083, China; Department of Pathogen Biology, School of Basic Medical Science, Peking University, Beijing, 100083, China.
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7
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Sharif N, Gilani SZ, Suter D, Reid S, Szulc P, Kimelman D, Monchka BA, Jozani MJ, Hodgson JM, Sim M, Zhu K, Harvey NC, Kiel DP, Prince RL, Schousboe JT, Leslie WD, Lewis JR. Machine learning for abdominal aortic calcification assessment from bone density machine-derived lateral spine images. EBioMedicine 2023; 94:104676. [PMID: 37442671 PMCID: PMC10435763 DOI: 10.1016/j.ebiom.2023.104676] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Lateral spine images for vertebral fracture assessment can be easily obtained on modern bone density machines. Abdominal aortic calcification (AAC) can be scored on these images by trained imaging specialists to assess cardiovascular disease risk. However, this process is laborious and requires careful training. METHODS Training and testing of model performance of the convolutional neural network (CNN) algorithm for automated AAC-24 scoring utilised 5012 lateral spine images (2 manufacturers, 4 models of bone density machines), with trained imaging specialist AAC scores. Validation occurred in a registry-based cohort study of 8565 older men and women with images captured as part of routine clinical practice for fracture risk assessment. Cox proportional hazards models were used to estimate the association between machine-learning AAC (ML-AAC-24) scores with future incident Major Adverse Cardiovascular Events (MACE) that including death, hospitalised acute myocardial infarction or ischemic cerebrovascular disease ascertained from linked healthcare data. FINDINGS The average intraclass correlation coefficient between imaging specialist and ML-AAC-24 scores for 5012 images was 0.84 (95% CI 0.83, 0.84) with classification accuracy of 80% for established AAC groups. During a mean follow-up 4 years in the registry-based cohort, MACE outcomes were reported in 1177 people (13.7%). With increasing ML-AAC-24 scores there was an increasing proportion of people with MACE (low 7.9%, moderate 14.5%, high 21.2%), as well as individual MACE components (all p-trend <0.001). After multivariable adjustment, moderate and high ML-AAC-24 groups remained significantly associated with MACE (HR 1.54, 95% CI 1.31-1.80 & HR 2.06, 95% CI 1.75-2.42, respectively), compared to those with low ML-AAC-24. INTERPRETATION The ML-AAC-24 scores had substantial levels of agreement with trained imaging specialists, and was associated with a substantial gradient of risk for cardiovascular events in a real-world setting. This approach could be readily implemented into these clinical settings to improve identification of people at high CVD risk. FUNDING The study was supported by a National Health and Medical Research Council of Australia Ideas grant and the Rady Innovation Fund, Rady Faculty of Health Sciences, University of Manitoba.
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Affiliation(s)
- Naeha Sharif
- Nutrition & Health Innovation Research Institute, Edith Cowan University, Perth, Australia; Centre for AI&ML, School of Science, Edith Cowan University, Perth, Australia; Department of Computer Science and Software Engineering, The University of Western Australia, Perth, Australia
| | - Syed Zulqarnain Gilani
- Nutrition & Health Innovation Research Institute, Edith Cowan University, Perth, Australia; Centre for AI&ML, School of Science, Edith Cowan University, Perth, Australia
| | - David Suter
- Nutrition & Health Innovation Research Institute, Edith Cowan University, Perth, Australia; Centre for AI&ML, School of Science, Edith Cowan University, Perth, Australia
| | - Siobhan Reid
- Department of Electrical and Computer Engineering, University of Manitoba, Winnipeg, Canada
| | - Pawel Szulc
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, Lyon, France
| | - Douglas Kimelman
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Barret A Monchka
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | | | - Jonathan M Hodgson
- Nutrition & Health Innovation Research Institute, Edith Cowan University, Perth, Australia; Medical School, The University of Western Australia, Perth, Australia
| | - Marc Sim
- Nutrition & Health Innovation Research Institute, Edith Cowan University, Perth, Australia; Medical School, The University of Western Australia, Perth, Australia
| | - Kun Zhu
- Medical School, The University of Western Australia, Perth, Australia; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Douglas P Kiel
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Richard L Prince
- Nutrition & Health Innovation Research Institute, Edith Cowan University, Perth, Australia; Medical School, The University of Western Australia, Perth, Australia
| | - John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners, Minneapolis, USA; Division of Health Policy and Management, University of Minnesota, Minneapolis, USA
| | - William D Leslie
- Departments of Medicine and Radiology, University of Manitoba, Winnipeg, Canada
| | - Joshua R Lewis
- Nutrition & Health Innovation Research Institute, Edith Cowan University, Perth, Australia; Medical School, The University of Western Australia, Perth, Australia; Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, the University of Sydney, Sydney, Australia.
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8
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Sheu A, O’Connell RL, Jenkins AJ, Tran T, Drury PL, Sullivan DR, Li L, Colman P, O’Brien R, Kesäniemi YA, Center JR, White CP, Keech AC. Factors associated with fragility fractures in type 2 diabetes: An analysis of the randomised controlled Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Diabetes Metab Res Rev 2023; 39:e3631. [PMID: 36893361 PMCID: PMC10909535 DOI: 10.1002/dmrr.3631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/23/2022] [Accepted: 02/25/2023] [Indexed: 03/11/2023]
Abstract
AIMS Fracture risk is elevated in some type 2 diabetes patients. Bone fragility may be associated with more clinically severe type 2 diabetes, although prospective studies are lacking. It is unknown which diabetes-related characteristics are independently associated with fracture risk. In this post-hoc analysis of fracture data from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial (ISRCTN#64783481), we hypothesised that diabetic microvascular complications are associated with bone fragility. MATERIALS AND METHODS The FIELD trial randomly assigned 9795 type 2 diabetes participants (aged 50-75 years) to receive oral co-micronised fenofibrate 200 mg (n = 4895) or placebo (n = 4900) daily for a median of 5 years. We used Cox proportional hazards models to identify baseline sex-specific diabetes-related parameters independently associated with incident fractures. RESULTS Over 49,470 person-years, 137/6138 men experienced 141 fractures and 143/3657 women experienced 145 fractures; incidence rates for the first fracture of 4∙4 (95% CI 3∙8-5∙2) and 7∙7 per 1000 person-years (95% CI 6∙5-9∙1), respectively. Fenofibrate had no effect on fracture outcomes. In men, baseline macrovascular disease (HR 1∙52, 95% CI 1∙05-2∙21, p = 0∙03), insulin use (HR 1∙62, HR 1∙03-2∙55, p = 0∙03), and HDL-cholesterol (HR 2∙20, 95% CI 1∙11-4∙36, p = 0∙02) were independently associated with fracture. In women, independent risk factors included baseline peripheral neuropathy (HR 2∙04, 95% CI 1∙16-3∙59, p = 0∙01) and insulin use (HR 1∙55, 95% CI 1∙02-2∙33, p = 0∙04). CONCLUSIONS Insulin use and sex-specific complications (in men, macrovascular disease; in women, neuropathy) are independently associated with fragility fractures in adults with type 2 diabetes.
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Affiliation(s)
- Angela Sheu
- Bone Biology DivisionGarvan Institute of Medical ResearchSydneyAustralia
- Clinical SchoolSt Vincent's HospitalFaculty of MedicineUniversity of New South Wales SydneySydneyAustralia
- Department of Endocrinology and DiabetesSt Vincent's HospitalSydneyAustralia
| | | | | | - Thach Tran
- Bone Biology DivisionGarvan Institute of Medical ResearchSydneyAustralia
- Clinical SchoolSt Vincent's HospitalFaculty of MedicineUniversity of New South Wales SydneySydneyAustralia
| | - Paul L. Drury
- Auckland Diabetes CentreAuckland District Health BoardAucklandNew Zealand
| | - David R. Sullivan
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownAustralia
- Royal Prince Alfred HospitalSydneyAustralia
| | - LiPing Li
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownAustralia
| | - Peter Colman
- Department of Diabetes and EndocrinologyRoyal Melbourne HospitalMelbourneAustralia
- Walter and Eliza Hall Institute of Medical ResearchMelbourneAustralia
- University of MelbourneMelbourneAustralia
| | - Richard O’Brien
- University of MelbourneMelbourneAustralia
- Austin HospitalMelbourneAustralia
| | - Y. Antero Kesäniemi
- Internal Medicine Research UnitMedical Research CenterOulu University HospitalOuluFinland
- University of OuluOuluFinland
| | - Jacqueline R. Center
- Bone Biology DivisionGarvan Institute of Medical ResearchSydneyAustralia
- Clinical SchoolSt Vincent's HospitalFaculty of MedicineUniversity of New South Wales SydneySydneyAustralia
- Department of Endocrinology and DiabetesSt Vincent's HospitalSydneyAustralia
| | - Christopher P. White
- Clinical SchoolPrince of Wales HospitalFaculty of MedicineUniversity of New South Wales SydneySydneyAustralia
- Department of Endocrinology and MetabolismPrince of Wales HospitalSydneyAustralia
| | - Anthony C. Keech
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownAustralia
- Royal Prince Alfred HospitalSydneyAustralia
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9
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Lin W, He C, Xie F, Chen T, Zheng G, Yin H, Chen H, Wang Z. Discordance in lumbar bone mineral density measurements by quantitative computed tomography and dual-energy X-ray absorptiometry in postmenopausal women: a prospective comparative study. Spine J 2023; 23:295-304. [PMID: 36343911 DOI: 10.1016/j.spinee.2022.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/18/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND CONTEXT Level-specific lumbar bone mineral density (BMD) evaluation of a single vertebral body can provide useful surgical planning and osteoporosis management information. Previous comparative studies have primarily focused on detecting spinal osteoporosis but not at specific levels. PURPOSE To compare the detection rate of lumbar osteoporosis between quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA); to explore and analyze the distribution models of QCT-derived BMD and DXA T-score at the specific levels; and to evaluate the diagnostic accuracy of level-specific BMD thresholds for the prediction of osteoporotic vertebral compression fracture (OVCF) in postmenopausal women. STUDY DESIGN/SETTING A comparative analysis of prospectively collected data comparing QCT-derived BMD with DXA T-score. PATIENT SAMPLE A total of 296 postmenopausal women who were referred to the spine service of a single academic institution were enrolled. OUTCOME MEASURES QCT-derived BMD and DXA T-score at specific levels, with or without osteoporotic vertebral compression fracture. METHODS Postmenopausal women who underwent QCT and DXA within a week of admission from May 2019 to June 2022 were enrolled. The diagnostic criteria for osteoporosis recommended by the World Health Organization and the American College of Radiology were used for lumbar osteoporotic diagnosis. To evaluate differences in lumbar BMD measurements at specific levels, a threshold of T score=-2.5 and QCT-derived BMD = 80 mg/cm3 were used to categorize level-specific lumbar BMD into low and high BMD. Disagreements in BMD categorization between DXA and QCT were classified as a minor or major discordance based on the definition by Woodson. Data between QCT and DXA were visualized in a stacked bar plot and analyzed. Correlations between DXA and QCT at the specific levels were evaluated using Pearson's linear correlation and scatter plots. Curve fitting of BMD distribution, receiver operating characteristic (ROC) and area under the curve (AUC) for each single vertebral level was performed. RESULTS Of the 296 patients, QCT diagnosed 61.1% as osteoporosis, 30.4% as osteopenia and 8.4% as normal. For those screened with DXA, 54.1% of the patients had osteoporosis, 29.4% had osteopenia and 16.6% had normal BMD. Diagnoses were concordant for 194 (65.5%) patients. Of the other 102 discordant patients, 5 (1.7%) were major and 97 (32.8%) were minor. Significant correlations in level-specific BMD between DXA and QCT were observed (p<.001), with Pearson's correlation coefficients ranging from 0.662 to 0.728. The correlation strength was in the order of L1 > L2 > L3 > L4. The low BMD detection rate for QCT was significantly higher than that for DXA at the L3 and L4 levels (65% vs. 47.9% and 68.1% vs 43.7, respectively, p<.001). Patients with OVCF showed significantly lower QCT-derived BMD (47.2 mg/cm3 vs. 83.2 mg/cm3, p<.001) and T-score (-3.39 vs. -1.98, p<.001) than those without OVCF. Among these patients, 82.8% (101/122) were diagnosed with osteoporosis by QCT measurement, while only 74.6% (91/122) were diagnosed by DXA. For discrimination between patients with and without OVCF, QCT-derived BMD showed better diagnosed performance (AUC range from 0.769 to 0.801) than DXA T-score (AUC range from 0.696 to 0.753). CONCLUSION QCT provided a more accurate evaluation of lumbar osteoporosis than DXA. The QCT-derived BMD measurements at a specific lumbar level have a high diagnostic performance for OVCF.
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Affiliation(s)
- Wentao Lin
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Chaoqin He
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China; The Second Clinical Medical College of Southern Medical University, Guangzhou, Guangdong, China
| | - Faqin Xie
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Tao Chen
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China; The Second Clinical Medical College of Southern Medical University, Guangzhou, Guangdong, China
| | - Guanghao Zheng
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China; The Second Clinical Medical College of Southern Medical University, Guangzhou, Guangdong, China
| | - Houjie Yin
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China; The Second Clinical Medical College of Southern Medical University, Guangzhou, Guangdong, China
| | - Haixiong Chen
- Department of Radiology and Image, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Zhiyun Wang
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China.
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10
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Sheu A, Greenfield JR, White CP, Center JR. Contributors to impaired bone health in type 2 diabetes. Trends Endocrinol Metab 2023; 34:34-48. [PMID: 36435679 DOI: 10.1016/j.tem.2022.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/30/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022]
Abstract
Type 2 diabetes (T2D) is associated with numerous complications, including increased risk of fragility fractures, despite seemingly protective factors [e.g., normal bone mineral density and increased body mass index(BMI)]. However, fracture risk in T2D is underestimated by current fracture risk calculators. Importantly, post-fracture mortality is worse in T2D following any fracture, highlighting the importance of identifying high-risk patients that may benefit from targeted management. Several diabetes-related factors are associated with increased fracture risk, including exogenous insulin therapy, vascular complications, and poor glycaemic control, although detailed comprehensive studies to identify the independent contributions of these factors are lacking. The underlying pathophysiological mechanisms are complex and multifactorial, with different factors contributing during the course of T2D disease. These include obesity, hyperinsulinaemia, hyperglycaemia, accumulation of advanced glycation end products, and vascular supply affecting bone-cell function and survival and bone-matrix composition. This review summarises the current understanding of the contributors to impaired bone health in T2D, and proposes an updated approach to managing these patients.
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Affiliation(s)
- Angela Sheu
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia; Clinical School, St Vincent's Hospital, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia; Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, Australia.
| | - Jerry R Greenfield
- Clinical School, St Vincent's Hospital, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia; Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, Australia; Diabetes and Metabolism, Garvan Institute of Medical Research, Sydney, Australia
| | - Christopher P White
- Clinical School, Prince of Wales Hospital, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia; Department of Endocrinology and Metabolism, Prince of Wales Hospital, Sydney, Australia
| | - Jacqueline R Center
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia; Clinical School, St Vincent's Hospital, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia; Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, Australia
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11
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Yano C, Yokomoto-Umakoshi M, Fujita M, Umakoshi H, Yano S, Iwahashi N, Katsuhara S, Kaneko H, Ogata M, Fukumoto T, Terada E, Matsuda Y, Sakamoto R, Ogawa Y. Coexistence of bone and vascular disturbances in patients with endogenous glucocorticoid excess. Bone Rep 2022; 17:101610. [PMID: 36035657 PMCID: PMC9398912 DOI: 10.1016/j.bonr.2022.101610] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/10/2022] [Indexed: 10/28/2022] Open
Abstract
Purpose Bone and vascular diseases are considered to share pathogenic mechanisms. Excess glucocorticoids, key regulators of cardiovascular and metabolic homeostasis, may promote both diseases simultaneously. We used endogenous Cushing's syndrome (CS) to investigate whether glucocorticoid excess underlies coexisting bone and vascular diseases. Methods We included 194 patients with adrenal tumors (ATs): autonomous cortisol secretion (ACS, n = 97) and non-functional AT (n = 97). ACS was further classified into overt CS (n = 17) and subclinical CS (SCS, n = 80). Arterial stiffness was defined as a brachial-ankle pulse wave velocity (baPWV) ≥ 1800 cm/s. Results Patients with ACS had higher coexistence rates of vertebral fracture and arterial stiffness (23 % vs. 2 %; p < 0.001) and vertebral fracture and abdominal aortic calcification (22 % vs. 1 %; p < 0.001) than those with non-functional AT. In patients with ACS, baPWV was negatively correlated with trabecular bone score (TBS, r = -0.33; p = 0.002), but not with bone mineral density, and vertebral fracture was associated with arterial stiffness in the logistic regression analysis. In the multivariate analysis of variance, the degree of cortisol excess (defined as CS, SCS, and non-functional AT) determined the correlation between TBS and baPWV (partial η2 = 0.07; p < 0.001). In the analysis of covariance, patients with coexisting vertebral fracture and arterial stiffness had higher levels of serum cortisol after the 1-mg dexamethasone suppression test than those without. Conclusion In endogenous glucocorticoid excess, bone and vascular diseases frequently coexisted, and deteriorated bone quality, not bone loss, was related to arterial stiffness. Thus, glucocorticoid excess may perturb the bone-vascular axis.
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Affiliation(s)
- Chieko Yano
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Maki Yokomoto-Umakoshi
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masamichi Fujita
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hironobu Umakoshi
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Seiichi Yano
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Norifusa Iwahashi
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Katsuhara
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroki Kaneko
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masatoshi Ogata
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tazuru Fukumoto
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eriko Terada
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yayoi Matsuda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryuichi Sakamoto
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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12
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The association between weight-adjusted-waist index and abdominal aortic calcification in adults aged ≥ 40 years: results from NHANES 2013-2014. Sci Rep 2022; 12:20354. [PMID: 36437292 PMCID: PMC9701694 DOI: 10.1038/s41598-022-24756-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 11/21/2022] [Indexed: 11/28/2022] Open
Abstract
The negative effects of obesity on the cardiovascular health have drawn much attention. Weight-adjusted-waist index (WWI) has been proved to reflect weight-independent centripetal obesity. However, the association between WWI and abdominal aortic calcification (AAC) has not been reported before. Using data from National Health and Nutrition Examination Survey 2013-2014, we aimed to determine the relationship of WWI and AAC in adults aged ≥ 40 years. WWI was determined by dividing waist circumference by the square root of weight. AAC was measured by dual-energy X-ray absorptiometry and quantified by Kauppila scores. Severe AAC (SAAC) was defined as an AAC score > 6. We utilized weighed multivariable logistic regression and generalized additive model to explore the independent association between WWI and AAC. Threshold effects were further calculated by two-piecewise linear regression model. 3082 participants were enrolled in our analysis, of which 48.2% were male. WWI was positively associated with AAC scores (β = 0.34, 95% CI 0.05-0.63) and exhibited a nonlinear relationship with SAAC. On the left of the breakpoint (WWI = 11.11), WWI and SAAC were positively associated (OR = 2.86, 95% CI 1.40-5.84), while no such relationship was found on the right (OR = 1.07, 95% CI 0.77-1.48). Our findings indicated that WWI may serve as a simple biomarker of AAC in US adults aged ≥ 40 years.
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13
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Dalla Via J, Sim M, Schousboe JT, Kiel DP, Zhu K, Hodgson JM, Gebre AK, Daly RM, Prince RL, Lewis JR. Association of Abdominal Aortic Calcification with Peripheral Quantitative Computed Tomography Bone Measures in Older Women: The Perth Longitudinal Study of Ageing Women. Calcif Tissue Int 2022; 111:485-494. [PMID: 35962793 PMCID: PMC9560937 DOI: 10.1007/s00223-022-01016-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/21/2022] [Indexed: 11/18/2022]
Abstract
We have previously shown that abdominal aortic calcification (AAC), a marker of advanced atherosclerotic disease, is weakly associated with reduced hip areal bone mineral density (aBMD). To better understand the vascular-bone health relationship, we explored this association with other key determinants of whole-bone strength and fracture risk at peripheral skeletal sites. This study examined associations of AAC with peripheral quantitative computed tomography (pQCT)-assessed total, cortical and trabecular volumetric BMD (vBMD), bone structure and strength of the radius and tibia among 648 community-dwelling older women (mean ± SD age 79.7 ± 2.5 years). We assessed associations between cross-sectional (2003) and longitudinal (progression from 1998/1999-2003) AAC assessed on lateral dual-energy X-ray absorptiometry (DXA) images with cross-sectional (2003) and longitudinal (change from 2003 to 2005) pQCT bone measures at the 4% radius and tibia, and 15% radius. Partial Spearman correlations (adjusted for age, BMI, calcium treatment) revealed no cross-sectional associations between AAC and any pQCT bone measures. AAC progression was not associated with any bone measure after adjusting for multiple comparisons, despite trends for inverse correlations with total bone area at the 4% radius (rs = - 0.088, p = 0.044), 4% tibia (rs = - 0.085, p = 0.052) and 15% radius (rs = - 0.101, p = 0.059). Neither AAC in 2003 nor AAC progression were associated with subsequent 2-year pQCT bone changes. ANCOVA showed no differences in bone measures between women with and without AAC or AAC progression, nor across categories of AAC extent. Collectively, these finding suggest that peripheral bone density and structure, or its changes with age, are not associated with central vascular calcification in older women.
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Affiliation(s)
- Jack Dalla Via
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.
| | - Marc Sim
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - John T Schousboe
- Park Nicollet Osteoporosis Center and Health Partners Institute, Minneapolis, MN, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Douglas P Kiel
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Kun Zhu
- Medical School, The University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Jonathan M Hodgson
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - Abadi K Gebre
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Richard L Prince
- Medical School, The University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Joshua R Lewis
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Medical School, The University of Western Australia, Perth, WA, Australia
- Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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14
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Uhlinova J, Kuudeberg A, Metsküla K, Lember M, Rosenberg M. Significant associations between bone mineral density and vascular calcification in patients with different stages of chronic kidney disease. BMC Nephrol 2022; 23:327. [PMID: 36199013 PMCID: PMC9533531 DOI: 10.1186/s12882-022-02955-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/21/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Chronic kidney disease—mineral and bone disorders (CKD-MBD) is characterised by generalised vascular calcification (VC) and impaired bone health. We aimed to investigate the relationship between VC and bone mineral density (BMD) in CKD patients. Methods We performed a cross-sectional study of patients with different stages of CKD. For assessment of VC of abdominal aorta lateral lumbar X-rays (Kauppila score), the ankle-brachial index (ABI) and echocardiography were used. Total body densitometry provided BMD. Results Ninety patients (41% male, median age 64 years (range 29–87)) were included, of whom 41.1% had a Kauppila score > 1. Evidence of peripheral VC as measured by ABI was detected in 23.3% of cases. Lesions of the heart valves were found in 46.7% of patients. There was a significant association between high ABI and lesions of the heart valves. In the multivariate regression model to analyse the independent determinants of abdominal aorta calcification (AAC) and ABI, the BMD of the femoral neck was identified as significant for both (p = 0.001, p = 0.001). The total spine BMD was found to be significant for AAC (p = 0.001), and the BMD of spine L1-L4 and the ribs were found to be significant for ABI (p = 0.01, p = 0.002 respectively). In factorial regression analysis, where BMD was independent determinant, valvular calcification was significant for BMD of femur, femoral neck and total BMD. Age and tALP were inversely correlated with the BMD of femur and femoral neck. Conclusions Our work highlighted clinically important relationships between VC and bone mineral density (BMD) in CKD patients. We detected inverse relationships between AAC, high ABI and BMD. Secondly, BMD at certain bone sites (femur, femoral neck) and total BMD were associated with important lesions of heart valves. Thirdly, a significant association between a high ABI and lesions of the heart valves. We believe that the results of our study will help in the planning of future research and in current clinical practice for the early diagnosis, further monitoring and management of CKD-MBD. Additionally, these results may have treatment implications on use of different CKD-MBD medications.
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Affiliation(s)
- Jana Uhlinova
- Department of Internal Medicine, Institute of Clinical Medicine, University of Tartu, Puusepa str. 8, 50406, Tartu, Estonia. .,Department of Internal Medicine, Tartu University Hospital, Tartu, Estonia.
| | - Anne Kuudeberg
- Department of Anatomy, Institute of Pathological Anatomy and Forensic Medicine, University of Tartu, Tartu, Estonia
| | - Kaja Metsküla
- Department of Immunology, Institute of Biomedicine and Translation Medicine, University of Tartu, Tartu, Estonia
| | - Margus Lember
- Department of Internal Medicine, Institute of Clinical Medicine, University of Tartu, Puusepa str. 8, 50406, Tartu, Estonia.,Department of Internal Medicine, Tartu University Hospital, Tartu, Estonia
| | - Mai Rosenberg
- Department of Internal Medicine, Institute of Clinical Medicine, University of Tartu, Puusepa str. 8, 50406, Tartu, Estonia.,Department of Internal Medicine, Tartu University Hospital, Tartu, Estonia
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15
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Gebre AK, Lewis JR, Leow K, Szulc P, Scott D, Ebeling PR, Sim M, Wong G, Lim WH, Schousboe JT, Kiel DP, Prince RL, Rodríguez AJ. Abdominal aortic calcification, bone mineral density and fractures: a systematic review and meta-analysis of observational studies. J Gerontol A Biol Sci Med Sci 2022:6674525. [PMID: 36000920 DOI: 10.1093/gerona/glac171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Abdominal aortic calcification (AAC) has been inconsistently associated with skeletal health. We aimed to investigate the association of AAC with bone mineral density (BMD) and fracture risk by pooling the findings of observational studies. METHODS Medline, EMBASE, Web of Science and Google Scholar were searched (August 2021). All clinical studies that assessed the association between AAC and BMD or fracture were included. AAC was categorized into any/advanced (all higher reported groups) vs no/less advanced (lowest reported group). Pooled standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (CI) were determined for BMD and fracture, respectively, using random-effects models. RESULTS Of 2,192 articles screened, 86 (61,553 participants) were included in the review, while 42 provided data for meta-analysis. AAC was associated with lower BMD at the total hip [SMD=-1.05 (95%CI: -1.47 to -0.63); 16 studies], femoral neck [-0.25 (-0.46 to - 0.04); 10] and lumbar spine [-0.67 (-1.21 to -0.12); 20]. AAC was associated with a greater risk of any fracture [RR= 1.73 (95%CI: 1.48 to 2.02); 27]. AAC was also associated with vertebral, non-vertebral and hip fractures. In dose-response analysis, the highest AAC group had greater risks of any, vertebral and non-vertebral fractures. CONCLUSIONS AAC is associated with lower BMD and increased fracture risk at multiple sites, underscoring the potential importance of vascular disease on skeletal health. Detection of AAC at the time of BMD testing may provide clinicians with prognostic information about bone health to enhance osteoporosis screening programs and fracture risk prediction.
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Affiliation(s)
- Abadi K Gebre
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray
| | - Joshua R Lewis
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Medical School, University of Western Australia, Perth, Australia.,Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Kevin Leow
- Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Pawel Szulc
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, Lyon, France
| | - David Scott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.,Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Peter R Ebeling
- Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Marc Sim
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Medical School, University of Western Australia, Perth, Australia
| | - Germaine Wong
- Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Wai H Lim
- Medical School, University of Western Australia, Perth, Australia.,Department of Renal Medicine, Sir Charles Gairdner Hospital, Western Australia, Australia
| | - John T Schousboe
- Park Nicollet Osteoporosis Center and HealthPartners Institute, HealthPartners, Minneapolis, MN 55416, USA, and Division of Health Policy and Management, University of Minnesota, Minneapolis, MN 55455, USA
| | - Douglas P Kiel
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard L Prince
- Medical School, University of Western Australia, Perth, Australia
| | - Alexander J Rodríguez
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
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16
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Gebre AK, Prince RL, Schousboe JT, Kiel DP, Thompson PL, Zhu K, Lim WH, Sim M, Lewis JR. Calcaneal quantitative ultrasound is associated with all-cause and cardiovascular disease mortality independent of hip bone mineral density. Osteoporos Int 2022; 33:1557-1567. [PMID: 35147712 PMCID: PMC9187548 DOI: 10.1007/s00198-022-06317-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 01/20/2022] [Indexed: 11/26/2022]
Abstract
UNLABELLED Osteoporosis has been linked with increased risk of cardiovascular disease previously. However, few studies have detailed bone and vascular information. In a prospective study of older women, we demonstrated heel quantitative ultrasound measures were associated with increased cardiovascular and all-cause mortality, independent of established cardiovascular risk factors. INTRODUCTION Osteoporosis and low bone mineral density (BMD) have been previously linked to cardiovascular disease (CVD) and mortality. Calcaneal quantitative ultrasound (QUS) is used to evaluate bone material properties, especially in older women. However, it is uncertain whether it is related to risk of mortality. This study was aimed to investigate the association between calcaneal QUS measurements and 15-year all-cause and CVD mortality in 1404 older women (mean age 75.2 ± 2.7 years). METHODS One thousand four hundred four older women, participants of Calcium Intake Fracture Outcome study (CAIFOS), had calcaneal bone measured at baseline (1998) and followed for 15 years. The primary outcomes, any deaths, and deaths attributable to cardiovascular causes ascertained by using linked data were obtained from Western Australia data linkage system. RESULTS Over the 15 years of follow-up (17,955 person years), 584 of the women died, and 223 from CVD. For every standard deviation (SD), reduction in broadband ultrasound attenuation (BUA) in minimally and multivariable-adjusted model including cardiovascular risk factors increased relative hazards for all-cause (multivariable-adjusted HR 1.15; 95%CI: 1.06-1.26, p = 0.001) and CVD mortality (multivariable-adjusted HR 1.20; 95%CI: 1.04-1.38, p = 0.010). Such relationships also persisted when hip BMD was included in the model (all-cause mortality HR 1.19; 95%CI: 1.07-1.33, p = 0.002; CVD mortality HR 1.28; 95%CI: 1.07-1.53, p = 0.008). CONCLUSION BUA is associated with all-cause and CVD mortality in older women independent of BMD and established CVD risk factors. Understanding why and how these are related may provide further insights about the bone-vascular nexus as well as therapeutic targets benefiting both systems.
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Affiliation(s)
- A K Gebre
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, 6027, Australia
- School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - R L Prince
- Medical School, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - J T Schousboe
- Park Nicollet Osteoporosis Center and HealthPartners Institute, HealthPartners, Minneapolis, MN, 55416, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, 55455, USA
| | - D P Kiel
- Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - P L Thompson
- Medical School, The University of Western Australia, Perth, Australia
- Department of Cardiology, Sir Charles Gairdner Hospital, Perth, Australia
| | - K Zhu
- Medical School, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - W H Lim
- Medical School, The University of Western Australia, Perth, Australia
- Renal Department, Sir Charles Gairdner Hospital, Perth, Australia
| | - M Sim
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, 6027, Australia
- Medical School, The University of Western Australia, Perth, Australia
| | - J R Lewis
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, 6027, Australia.
- Medical School, The University of Western Australia, Perth, Australia.
- Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
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17
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Byun KA, Oh S, Yang JY, Lee SY, Son KH, Byun K. Ecklonia cava extracts decrease hypertension-related vascular calcification by modulating PGC-1α and SOD2. Biomed Pharmacother 2022; 153:113283. [PMID: 35717781 DOI: 10.1016/j.biopha.2022.113283] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 11/02/2022] Open
Abstract
Vascular calcification (VC) is induced by a decrease in sirtuin 3 (SIRT3) and superoxide dismutase (SOD)2 and increases mitochondrial reactive oxygen species (mtROS), eventually leading to mitochondrial dysfunction and phenotype alterations in vascular smooth muscle cells (VSMCs) into osteoblast-like cells in hypertension. Ecklonia cava extract (ECE) is known to increase peroxisome proliferator-activated receptor-gamma coactivator-1 alpha (PGC-1α) and SOD2. In this study, we evaluated the effect of ECE on decreasing VC by increasing PGC-1α which increased SOD2 activity and decreased mtROS in an in vitro VSMC model of treating serums from Wistar Kyoto (WKY), spontaneous hypertensive rats (SHRs), and ECE-treated SHRs. Furthermore, the decreasing effect of ECE on VC was evaluated with an in vivo SHR model. PGC-1α expression, SIRT3 expression, and SOD2 activity were decreased by the serum from the SHRs and increased by the serum from the ECE-treated SHRs in the VSMCs. PGC-1α silencing eliminated those increases. mtROS generation and mitochondrial DNA (mtDNA) damage increased in the SHRs but decreased with ECE. Mitochondrial fission increased in the SHRs but decreased by ECE. Mitochondrial fusion, mitophagy, and mitochondrial biogenesis were decreased in the SHRs but increased by ECE. Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase and calcium deposition in the medial layer of the aorta increased in the SHRs but decreased with ECE. Therefore, ECE decreases VC via the upregulation of PGC-1α and SIRT3, which increases SOD2 activity. Activated SOD2 decreases mtDNA damage and mtROS generation, which sequentially decreases NADPH oxidase activity and changes the mitochondrial dynamics, thereby decreasing VC.
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Affiliation(s)
- Kyung-A Byun
- Department of Anatomy & Cell Biology, Gachon University College of Medicine, Incheon 21936, Republic of Korea; Functional Cellular Networks Laboratory, Lee Gil Ya Cancer and Diabetes Institute, Gachon University College of Medicine, Incheon 21999, Republic of Korea
| | - Seyeon Oh
- Functional Cellular Networks Laboratory, Lee Gil Ya Cancer and Diabetes Institute, Gachon University College of Medicine, Incheon 21999, Republic of Korea
| | - Jin Young Yang
- Functional Cellular Networks Laboratory, Lee Gil Ya Cancer and Diabetes Institute, Gachon University College of Medicine, Incheon 21999, Republic of Korea
| | - So Young Lee
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University, Incheon 21565, Republic of Korea
| | - Kuk Hui Son
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University, Incheon 21565, Republic of Korea.
| | - Kyunghee Byun
- Department of Anatomy & Cell Biology, Gachon University College of Medicine, Incheon 21936, Republic of Korea; Functional Cellular Networks Laboratory, Lee Gil Ya Cancer and Diabetes Institute, Gachon University College of Medicine, Incheon 21999, Republic of Korea.
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18
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Zengin A, Shore-Lorenti C, Sim M, Maple-Brown L, Brennan-Olsen SL, Lewis JR, Ockwell J, Walker T, Scott D, Ebeling P. Why Aboriginal and Torres Strait Islander Australians fall and fracture: the codesigned Study of Indigenous Muscle and Bone Ageing (SIMBA) protocol. BMJ Open 2022; 12:e056589. [PMID: 35379631 PMCID: PMC8981296 DOI: 10.1136/bmjopen-2021-056589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Aboriginal and Torres Strait Islander Australians have a substantially greater fracture risk, where men are 50% and women are 26% more likely to experience a hip fracture compared with non-Indigenous Australians. Fall-related injuries in this population have also increased by 10%/year compared with 4.3%/year in non-Indigenous Australians. This study aims to determine why falls and fracture risk are higher in Aboriginal and Torres Strait Islander Australians. SETTING All clinical assessments will be performed at one centre in Melbourne, Australia. At baseline, participants will have clinical assessments, including questionnaires, anthropometry, bone structure, body composition and physical performance tests. These assessments will be repeated at follow-up 1 and follow-up 2, with an interval of 12 months between each clinical visit. PARTICIPANTS This codesigned prospective observational study aims to recruit a total of 298 adults who identify as Aboriginal and Torres Strait Islander and reside within Victoria, Australia. Stratified sampling by age and sex will be used to ensure equitable distribution of men and women across four age-bands (35-44, 45-54, 55-64 and 65+ years). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome is within-individual yearly change in areal bone mineral density at the total hip, femoral neck and lumbar spine assessed by dual energy X-ray absorptiometry. Within-individual change in cortical and trabecular volumetric bone mineral density at the radius and tibia using high-resolution peripheral quantitative computed tomography will be determined. Secondary outcomes include yearly differences in physical performance and body composition. ETHICAL APPROVAL Ethics approval for this study has been granted by the Monash Health Human Research Ethics Committee (project number: RES-19-0000374A). TRIAL REGISTRATION NUMBER ACTRN12620000161921.
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Affiliation(s)
- Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Cat Shore-Lorenti
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Marc Sim
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, Royal Perth Hospital Unit, The University of Western Australia, Perth, Western Australia, Australia
| | - Louise Maple-Brown
- Charles Darwin University, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Endocrinology Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Sharon Lee Brennan-Olsen
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Victoria, Australia
- Department of Medicine-Western Health, University of Melbourne, St Albans, Victoria, Australia
| | - Joshua R Lewis
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, Royal Perth Hospital Unit, The University of Western Australia, Perth, Western Australia, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer Ockwell
- Bunurong Health Service, Dandenong & District Aborigines Co-operative Ltd (DDACL), Dandenong, Victoria, Australia
| | - Troy Walker
- Health & Wellbeing, A2B Personnel, Echuca, Victoria, Australia
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Peter Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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19
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Identification of Potential Targets Linked to the Cardiovascular/Alzheimer’s Axis through Bioinformatics Approaches. Biomedicines 2022; 10:biomedicines10020389. [PMID: 35203598 PMCID: PMC8962298 DOI: 10.3390/biomedicines10020389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 12/23/2022] Open
Abstract
The identification of common targets in Alzheimer’s disease (AD) and cardiovascular disease (CVD) in recent years makes the study of the CVD/AD axis a research topic of great interest. Besides aging, other links between CVD and AD have been described, suggesting the existence of common molecular mechanisms. Our study aimed to identify common targets in the CVD/AD axis. For this purpose, genomic data from calcified and healthy femoral artery samples were used to identify differentially expressed genes (DEGs), which were used to generate a protein–protein interaction network, where a module related to AD was identified. This module was enriched with the functionally closest proteins and analyzed using different centrality algorithms to determine the main targets in the CVD/AD axis. Validation was performed by proteomic and data mining analyses. The proteins identified with an important role in both pathologies were apolipoprotein E and haptoglobin as DEGs, with a fold change about +2 and −2, in calcified femoral artery vs healthy artery, respectively, and clusterin and alpha-2-macroglobulin as close interactors that matched in our proteomic analysis. However, further studies are needed to elucidate the specific role of these proteins, and to evaluate its function as biomarkers or therapeutic targets.
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20
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Mace ML, Gravesen E, Nordholm A, Egstrand S, Morevati M, Olgaard K, Lewin E. The calcified vasculature in chronic kidney disease secretes factors that inhibit bone mineralization. JBMR Plus 2022; 6:e10610. [PMID: 35434452 PMCID: PMC9009125 DOI: 10.1002/jbm4.10610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/03/2022] [Accepted: 01/26/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
| | | | - Anders Nordholm
- Department of Nephrology Rigshospitalet
- Department of Nephrology Herlev Hospital University of Copenhagen Denmark
| | - Soeren Egstrand
- Department of Nephrology Rigshospitalet
- Department of Nephrology Herlev Hospital University of Copenhagen Denmark
| | | | | | - Ewa Lewin
- Department of Nephrology Rigshospitalet
- Department of Nephrology Herlev Hospital University of Copenhagen Denmark
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21
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Chen TY, Yang J, Zuo L, Wang L, Wang LF. Relationship of abdominal aortic calcification with lumbar vertebral volumetric bone mineral density assessed by quantitative computed tomography in maintenance hemodialysis patients. Arch Osteoporos 2022; 17:24. [PMID: 35080671 PMCID: PMC8791896 DOI: 10.1007/s11657-022-01059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/29/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION This cross-sectional study aimed to investigate the relationship between abdominal aortic calcification (AAC), which is a marker of vascular calcification, and volumetric bone mineral density (vBMD) by quantitative computed tomography (QCT) in maintenance hemodialysis (MHD) patients. METHODS All participants underwent lumbar vertebral vBMD measurement by QCT. Eight cross-sections were extracted sequentially and analyzed by ImageJ software to obtain the ratio of the calcified area to the abdominal aortic area (the calcification ratio). The AAC score was determined by the sum of the calcification ratios. The relationship between AAC and vBMD was analyzed using multivariate logistic regression. RESULTS Ninety MHD patients (58.89% male) with a mean age of 63.43 (standard deviation [SD] = 13.20) years were included in the study. AAC was present (AAC score > 0) in 93.33% of the patients. The 75th percentile of the AAC score corresponding to 119 was used as the cutoff point between the mild and severe groups. After full adjustment in the logistic model, AAC was found to be inversely associated with vBMD (odds ratio [OR], 0.970; 95% confidence interval [CI], 0.944 to 0.996; P = 0.025), and patients with osteoporosis had a significantly higher risk of severe AAC than those with normal bone mass (OR, 14.498; 95% CI, 1.507 to 139.486; P = 0.021). The independent inverse association was still stable after adjusting for variables measured at different time periods and using different cutoff points of the AAC score. CONCLUSION There was an independent inverse association between AAC and vBMD, and osteoporosis was significantly associated with severe AAC in patients with MHD.
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Affiliation(s)
- Tian-Yi Chen
- Department of Renal Medicine, Beijing Jishuitan Hospital, No. 68, Hui-South Road, Hui- Longguan Town, Changping District, 100096, Beijing, China.
| | - Jie Yang
- Department of Renal Medicine, Beijing Jishuitan Hospital, No. 68, Hui-South Road, Hui- Longguan Town, Changping District, 100096, Beijing, China
| | - Li Zuo
- Department of Renal Medicine, Peking University People's Hospital, Beijing, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Li-Fang Wang
- Clinical Epidemiology Research Center, Beijing Jishuitan Hospital, Beijing, China
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22
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Rauner M, Foessl I, Formosa MM, Kague E, Prijatelj V, Lopez NA, Banerjee B, Bergen D, Busse B, Calado Â, Douni E, Gabet Y, Giralt NG, Grinberg D, Lovsin NM, Solan XN, Ostanek B, Pavlos NJ, Rivadeneira F, Soldatovic I, van de Peppel J, van der Eerden B, van Hul W, Balcells S, Marc J, Reppe S, Søe K, Karasik D. Perspective of the GEMSTONE Consortium on Current and Future Approaches to Functional Validation for Skeletal Genetic Disease Using Cellular, Molecular and Animal-Modeling Techniques. Front Endocrinol (Lausanne) 2021; 12:731217. [PMID: 34938269 PMCID: PMC8686830 DOI: 10.3389/fendo.2021.731217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/30/2021] [Indexed: 12/26/2022] Open
Abstract
The availability of large human datasets for genome-wide association studies (GWAS) and the advancement of sequencing technologies have boosted the identification of genetic variants in complex and rare diseases in the skeletal field. Yet, interpreting results from human association studies remains a challenge. To bridge the gap between genetic association and causality, a systematic functional investigation is necessary. Multiple unknowns exist for putative causal genes, including cellular localization of the molecular function. Intermediate traits ("endophenotypes"), e.g. molecular quantitative trait loci (molQTLs), are needed to identify mechanisms of underlying associations. Furthermore, index variants often reside in non-coding regions of the genome, therefore challenging for interpretation. Knowledge of non-coding variance (e.g. ncRNAs), repetitive sequences, and regulatory interactions between enhancers and their target genes is central for understanding causal genes in skeletal conditions. Animal models with deep skeletal phenotyping and cell culture models have already facilitated fine mapping of some association signals, elucidated gene mechanisms, and revealed disease-relevant biology. However, to accelerate research towards bridging the current gap between association and causality in skeletal diseases, alternative in vivo platforms need to be used and developed in parallel with the current -omics and traditional in vivo resources. Therefore, we argue that as a field we need to establish resource-sharing standards to collectively address complex research questions. These standards will promote data integration from various -omics technologies and functional dissection of human complex traits. In this mission statement, we review the current available resources and as a group propose a consensus to facilitate resource sharing using existing and future resources. Such coordination efforts will maximize the acquisition of knowledge from different approaches and thus reduce redundancy and duplication of resources. These measures will help to understand the pathogenesis of osteoporosis and other skeletal diseases towards defining new and more efficient therapeutic targets.
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Affiliation(s)
- Martina Rauner
- Department of Medicine III, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- University Hospital Carl Gustav Carus, Dresden, Germany
| | - Ines Foessl
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Endocrine Lab Platform, Medical University of Graz, Graz, Austria
| | - Melissa M. Formosa
- Department of Applied Biomedical Science, Faculty of Health Sciences, University of Malta, Msida, Malta
- Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta
| | - Erika Kague
- School of Physiology, Pharmacology, and Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
| | - Vid Prijatelj
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- The Generation R Study, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Nerea Alonso Lopez
- Rheumatology and Bone Disease Unit, CGEM, Institute of Genetics and Cancer (IGC), Edinburgh, United Kingdom
| | - Bodhisattwa Banerjee
- Musculoskeletal Genetics Laboratory, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Dylan Bergen
- School of Physiology, Pharmacology, and Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ângelo Calado
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Eleni Douni
- Department of Biotechnology, Agricultural University of Athens, Athens, Greece
- Institute for Bioinnovation, B.S.R.C. “Alexander Fleming”, Vari, Greece
| | - Yankel Gabet
- Department of Anatomy & Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natalia García Giralt
- Musculoskeletal Research Group, IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red en Fragilidad y Envejecimiento Saludable (CIBERFES), ISCIII, Barcelona, Spain
| | - Daniel Grinberg
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, Universitat de Barcelona, CIBERER, IBUB, IRSJD, Barcelona, Spain
| | - Nika M. Lovsin
- Department of Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Xavier Nogues Solan
- Musculoskeletal Research Group, IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red en Fragilidad y Envejecimiento Saludable (CIBERFES), ISCIII, Barcelona, Spain
| | - Barbara Ostanek
- Department of Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Nathan J. Pavlos
- Bone Biology & Disease Laboratory, School of Biomedical Sciences, The University of Western Australia, Nedlands, WA, Australia
| | | | - Ivan Soldatovic
- Institute of Medical Statistics and Informatic, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jeroen van de Peppel
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Bram van der Eerden
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Wim van Hul
- Department of Medical Genetics, University of Antwerp, Antwerp, Belgium
| | - Susanna Balcells
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, Universitat de Barcelona, CIBERER, IBUB, IRSJD, Barcelona, Spain
| | - Janja Marc
- Department of Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Sjur Reppe
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Kent Søe
- Clinical Cell Biology, Department of Pathology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - David Karasik
- Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
- Marcus Research Institute, Hebrew SeniorLife, Boston, MA, United States
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23
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Fusaro M, Tripepi G, Plebani M, Politi C, Aghi A, Taddei F, Schileo E, Zaninotto M, La Manna G, Cianciolo G, Gallieni M, Cosmai L, Messa P, Ravera M, Nickolas TL, Ferrari S, Ketteler M, Iervasi G, Mereu MC, Vettor R, Giannini S, Gasperoni L, Sella S, Brandi ML, Cianferotti L, De Caterina R. The Vessels-Bone Axis: Iliac Artery Calcifications, Vertebral Fractures and Vitamin K from VIKI Study. Nutrients 2021; 13:nu13103567. [PMID: 34684568 PMCID: PMC8539275 DOI: 10.3390/nu13103567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 01/07/2023] Open
Abstract
Vascular calcification and fragility fractures are associated with high morbidity and mortality, especially in end-stage renal disease. We evaluated the relationship of iliac arteries calcifications (IACs) and abdominal aortic calcifications (AACs) with the risk for vertebral fractures (VFs) in hemodialysis patients. The VIKI study was a multicenter cross-sectional study involving 387 hemodialysis patients. The biochemical data included bone health markers, such as vitamin K levels, vitamin K-dependent proteins, vitamin 25(OH)D, alkaline phosphatase, parathormone, calcium, and phosphate. VF, IACs and AACs was determined through standardized spine radiograms. VF was defined as >20% reduction of vertebral body height, and VC were quantified by measuring the length of calcium deposits along the arteries. The prevalence of IACs and AACs were 56.1% and 80.6%, respectively. After adjusting for confounding variables, the presence of IACs was associated with 73% higher odds of VF (p = 0.028), whereas we found no association (p = 0.294) for AACs. IACs were associated with VF irrespective of calcification severity. Patients with IACs had lower levels of vitamin K2 and menaquinone 7 (0.99 vs. 1.15 ng/mL; p = 0.003), and this deficiency became greater with adjustment for triglycerides (0.57 vs. 0.87 ng/mL; p < 0.001). IACs, regardless of their extent, are a clinically relevant risk factor for VFs. The association is enhanced by adjusting for vitamin K, a main player in bone and vascular health. To our knowledge these results are the first in the literature. Prospective studies are needed to confirm these findings both in chronic kidney disease and in the general population.
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Affiliation(s)
- Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), 56124 Pisa, Italy
- Department of Medicine, University of Padova, 35128 Padova, Italy; (G.I.); (R.V.)
- Correspondence:
| | - Giovanni Tripepi
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, 89124 Reggio Calabria, Italy; (G.T.); (C.P.)
| | - Mario Plebani
- Laboratory Medicine Unit, Department of Medicine, University of Padua, 35129 Padua, Italy; (M.P.); (M.Z.)
| | - Cristina Politi
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, 89124 Reggio Calabria, Italy; (G.T.); (C.P.)
| | - Andrea Aghi
- Clinica Medica 1, Department of Medicine, University of Padua, 35128 Padua, Italy; (A.A.); (S.G.); (S.S.)
| | - Fulvia Taddei
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.T.); (E.S.)
| | - Enrico Schileo
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.T.); (E.S.)
| | - Martina Zaninotto
- Laboratory Medicine Unit, Department of Medicine, University of Padua, 35129 Padua, Italy; (M.P.); (M.Z.)
| | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy; (G.L.M.); (G.C.); (L.G.)
| | - Giuseppe Cianciolo
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy; (G.L.M.); (G.C.); (L.G.)
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università di Milano, 20157 Milano, Italy;
| | - Laura Cosmai
- Nephrology Unit, ASST Fate Bene Fratelli Sacco, 20157 Milano, Italy;
| | - Piergiorgio Messa
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20157 Milan, Italy;
- Department of Clinical Sciences and Community Health, University of Milan, 20157 Milan, Italy
| | | | - Thomas L. Nickolas
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA;
| | - Serge Ferrari
- Service des Maladies Osseuses, Département de Médecine, HUG, 1205 Genève, Switzerland;
| | - Markus Ketteler
- Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany;
| | - Giorgio Iervasi
- Department of Medicine, University of Padova, 35128 Padova, Italy; (G.I.); (R.V.)
| | | | - Roberto Vettor
- Department of Medicine, University of Padova, 35128 Padova, Italy; (G.I.); (R.V.)
| | - Sandro Giannini
- Clinica Medica 1, Department of Medicine, University of Padua, 35128 Padua, Italy; (A.A.); (S.G.); (S.S.)
| | - Lorenzo Gasperoni
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy; (G.L.M.); (G.C.); (L.G.)
| | - Stefania Sella
- Clinica Medica 1, Department of Medicine, University of Padua, 35128 Padua, Italy; (A.A.); (S.G.); (S.S.)
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (M.L.B.); (L.C.)
| | - Luisella Cianferotti
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (M.L.B.); (L.C.)
| | - Raffaele De Caterina
- Cardiology, Cardiovascular Division, Pisa University Hospital, University of Pisa, Via Paradisa 2, 56126 Pisa, Italy;
- Fondazione Villa Serena per la Ricerca, Città Sant’Angelo, 65013 Pescara, Italy
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Silva PPB, Pereira RMR, Takayama L, Borba CG, Duarte FH, Trarbach EB, Martin RM, Bronstein MD, Tritos NA, Jallad RS. Impaired Bone Microarchitecture in Premenopausal Women With Acromegaly: The Possible Role of Wnt Signaling. J Clin Endocrinol Metab 2021; 106:2690-2706. [PMID: 33871626 DOI: 10.1210/clinem/dgab260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Indexed: 12/17/2022]
Abstract
CONTEXT Acromegaly can impair bone integrity, increasing the risk of vertebral fractures (VFs). OBJECTIVE To evaluate the impact of isolated GH/IGF-I hypersecretion on bone turnover markers, Wnt inhibitors, bone mineral density (BMD), microarchitecture, bone strength and vertebral fractures in female patients with acromegaly (Acro), compared with healthy control group (HC). DESIGN, SETTING, AND PATIENTS Cross-sectional study including 83 premenopausal women without any pituitary deficiency:18 acromegaly in remission (AcroR), 12 in group with active acromegaly (AcroA), and 53 HC. Serum procollagen type 1 N-terminal propeptide, β-carboxy-terminal crosslinked telopeptide of type 1 collagen, osteocalcin, sclerostin, and DKK1 were measured in blood samples. dual-energy X-ray absorptiometry, high-resolution peripheral quantitative computed tomography (HR-pQCT) and vertebral fractures evaluation were also assessed simultaneously. MAIN OUTCOME AND RESULTS AcroA showed significantly lower sclerostin and higher DKK1 compared with HC. On HR-pQCT of tibia and radius, Acro showed impairment of trabecular (area and trabecular number), increased cortical porosity, and increased cortical area and cortical thickness compared with HC. The only significant correlation found with HR-pQCT parameters was a positive correlation between cortical porosity and serum DKK1 (R = 0.45, P = 0.044). Mild VFs were present in approximately 30% of patients. CONCLUSIONS Eugonadal women with acromegaly without any pituitary deficiency showed increased cortical BMD, impairment of trabecular bone microstructure, and increased VF. Sclerostin was not correlated with any HR-pQCT parameters; however, DKK1 was correlated with cortical porosity in tibia (P = 0.027). Additional studies are needed to clarify the role of Wnt inhibitors on bone microarchitecture impairment in acromegaly.
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Affiliation(s)
- Paula P B Silva
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, SP 05403-010, Brazil
| | - Rosa M R Pereira
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, SP 01246903, Brazil
- Rheumatology Division Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP 05403-010, Brazil
| | - Liliam Takayama
- Rheumatology Division Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP 05403-010, Brazil
| | - Clarissa G Borba
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, SP 05403-010, Brazil
| | - Felipe H Duarte
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, SP 05403-010, Brazil
| | - Ericka B Trarbach
- Laboratorio de Endocrinologia Celular e Molecular/LIM25, Disciplina de Endocrinologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP 01246903, Brasil
| | - Regina Matsunaga Martin
- Diseases Unit Osteometabolic, Endocrinology Service, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP), São Paulo, SP 05403-010, Brazil
| | - Marcello D Bronstein
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, SP 05403-010, Brazil
- Laboratorio de Endocrinologia Celular e Molecular/LIM25, Disciplina de Endocrinologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP 01246903, Brasil
| | - Nicholas A Tritos
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Raquel S Jallad
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, SP 05403-010, Brazil
- Laboratorio de Endocrinologia Celular e Molecular/LIM25, Disciplina de Endocrinologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP 01246903, Brasil
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25
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Reid S, Schousboe JT, Kimelman D, Monchka BA, Jafari Jozani M, Leslie WD. Machine learning for automated abdominal aortic calcification scoring of DXA vertebral fracture assessment images: A pilot study. Bone 2021; 148:115943. [PMID: 33836309 DOI: 10.1016/j.bone.2021.115943] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Abdominal aortic calcification (AAC) identified on dual-energy x-ray absorptiometry (DXA) vertebral fracture assessment (VFA) lateral spine images is predictive of cardiovascular outcomes, but is time-consuming to perform manually. Whether this procedure can be automated using convolutional neural networks (CNNs), a class of machine learning algorithms used for image processing, has not been widely investigated. METHODS Using the Province of Manitoba Bone Density Program DXA database, we selected a random sample of 1100 VFA images from individuals qualifying for VFA as part of their osteoporosis assessment. For each scan, AAC was manually scored using the 24-point semi-quantitative scale and categorized as low (score < 2), moderate (score 2 to <6), or high (score ≥ 6). An ensemble consisting of two CNNs was developed, by training and evaluating separately on single-energy and dual-energy images. AAC prediction was performed using the mean AAC score of the two models. RESULTS Mean (SD) age of the cohort was 75.5 (6.7) years, 95.5% were female. Training (N = 770, 70%), validation (N = 110, 10%) and test sets (N = 220, 20%) were well-balanced with respect to baseline characteristics and AAC scores. For the test set, the Pearson correlation between the CNN-predicted and human-labelled scores was 0.93 with intraclass correlation coefficient for absolute agreement 0.91 (95% CI 0.89-0.93). Kappa for AAC category agreement (prevalence- and bias-adjusted, ordinal scale) was 0.71 (95% CI 0.65-0.78). There was complete separation of the low and high categories, without any low AAC score scans predicted to be high and vice versa. CONCLUSIONS CNNs are capable of detecting AAC in VFA images, with high correlation between the human and predicted scores. These preliminary results suggest CNNs are a promising method for automatically detecting and quantifying AAC.
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Affiliation(s)
| | - John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, Bloomington, MN, USA; University of Minnesota, Minneapolis, MN, USA.
| | - Douglas Kimelman
- University of Manitoba, Winnipeg, Canada; St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
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26
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Rodríguez AJ, Abrahamsen B. Cardiovascular Safety of Antifracture Medications in Patients With Osteoporosis: A Narrative Review of Evidence From Randomized Studies. JBMR Plus 2021; 5:e10522. [PMID: 34258509 PMCID: PMC8260817 DOI: 10.1002/jbm4.10522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/02/2021] [Indexed: 01/10/2023] Open
Abstract
Osteoporosis and cardiovascular (CV) disease share common risk factors and pathophysiology. Low bone mineral density (BMD) and fractures appear to increase the risk for multiple CV diseases. Equally, prevalent CV disease appears to predispose to bone loss and increase fracture rates. This relationship has naturally provoked the hypothesis that stopping bone loss may result in some CV benefit. Secondary analyses of safety and adverse event data from many randomized controlled trials (RCTs) have attempted to clarify this putative association. Recently, the discontinuation of odanacatib (anti-cathepsin K monoclonal antibody) over stroke concerns and the imbalance in ischemic events in romosozumab-treated (anti-sclerostin monoclonal antibody) women compared to bisphosphonate-treated women, has provided further justification to better characterize potential CV benefits and harms of osteoporosis medications. This review delves into the seminal, and other major RCTs of osteoporosis medications and, using both published data and additional information provided on trial registration pages, examines the evidence for CV safety and harms of these medications. Accepted and emerging "off-target" effects are explored for validity, biological plausibility, and clinical importance. A brief research agenda is provided to stimulate the next wave of clinical development and CV understanding of osteoporosis medications. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Alexander J Rodríguez
- Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences Monash University, Monash Medical Centre Clayton Victoria Australia.,Disorders of Mineralisation Research Group, School of Medical and Health Sciences Edith Cowan University Joondalup Western Australia Australia
| | - Bo Abrahamsen
- Department of Medicine Holbæk Hospital Holbæk Denmark.,Odense Patient Data Explorative Network (OPEN) University of Southern Denmark Odense Denmark
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27
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Park J, Yoon YE, Kim KM, Hwang IC, Lee W, Cho GY. Prognostic value of lower bone mineral density in predicting adverse cardiovascular disease in Asian women. Heart 2021; 107:1040-1046. [PMID: 33963047 DOI: 10.1136/heartjnl-2020-318764] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/05/2021] [Accepted: 03/13/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE We investigated whether the evaluation of bone mineral density (BMD) provides independent and incremental prognostic value for predicting atherosclerotic cardiovascular disease (ASCVD) in women. METHODS A total of 12 681 women aged 50-80 years (mean, 63.0±7.8 years) who underwent dual-energy X-ray absorptiometry were retrospectively analysed. We assessed the hazard ratio (HR) for ASCVD events (ASCVD death, non-fatal myocardial infarction and ischaemic stroke) according to the BMD or a clinical diagnosis of osteopenia or osteoporosis, with adjustment for clinical risk factors, including age, body mass index, hypertension, type 2 diabetes, hyperlipidaemia, current smoking and previous fracture. We also evaluated whether the addition of BMD or a clinical diagnosis of osteopenia or osteoporosis to clinical risk factors improved the prediction for ASCVD events. RESULTS In total, 468 women (3.7%) experienced ASCVD events during follow-up (median, 9.2 years). Lower BMD at the lumbar spine, femur neck and total hip was independently associated with higher risk for ASCVD events (adjusted HR per 1-standard deviation decrease in BMD: 1.16, p<0.001; 1.29, p<0.001; 1.38, p<0.001; respectively). A clinical diagnosis of osteoporosis was also independently associated with higher risk for ASCVD events (adjusted HR: 1.79, p<0.001). The addition of BMD or a clinical diagnosis of osteopenia or osteoporosis to clinical risk factors demonstrated significant incremental value in discriminating ASCVD events (addition of total hip BMD, p for difference <0.001). CONCLUSION The evaluation of BMD provides independent and incremental prognostic value for ASCVD in women and thus may improve risk stratification in women.
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Affiliation(s)
- Jiesuck Park
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeonyee Elizabeth Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Min Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - In-Chang Hwang
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wonjae Lee
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Goo-Yeong Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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28
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Ascending Aortic Calcification as a Potential Predictor for Low Bone Mineral Density: A Pilot Study. J Osteoporos 2021; 2021:5526359. [PMID: 34136118 PMCID: PMC8177974 DOI: 10.1155/2021/5526359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/03/2021] [Accepted: 05/18/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Identifying the factors related to low bone mineral density (BMD) can have significant implications for preventing hip fractures. The correlation between ascending aortic calcification and BMD has never been reported. Therefore, the purpose of the current study is to confirm the hypothesis that ascending aortic calcification can be used as a predictive factor for low BMD and to find a radiographic sign to show it. METHOD Plain film and computed tomography (CT) images of the thorax were obtained from 91 patients with hip fractures. Using the images, the calcification line of the ascending aorta adjacent to the aortic arch was evaluated. A prominent calcification line confirmed by both plain film and CT was classified as +2. A line which was ambiguous on plain film but confirmed by CT was classified as +1. Cases with no calcification were categorized as 0 (control). We compared the classified score with the BMD and calculated the kappa coefficient to measure intraobserver reliabilities for this radiographic finding. RESULTS Twenty-eight patients showed a +2 line, twenty-four patients showed a +1 line, and thirty-nine patients showed 0 lines. The median BMD of each group was 0.37 for the +2 line, 0.45 for the +1 line, and 0.51 for the 0 line. The BMD for the +2 group was significantly lower than the others. The kappa coefficient was approximately 0.6 (p < 0.01). CONCLUSION The imaging finding of calcification of the ascending aorta might be considered as a potential surrogate marker of low BMD. In such subjects, BMD might be ordered for the confirmation of diagnosis of osteoporosis. Mini-Abstract. The Aortic Arch Tail Sign, a calcification line on the ascending aorta, was relevant to low BMD in the current study. BMD can be ordered for the confirmation of diagnosis of osteoporosis in a subject incidentally found to have ascending aorta calcification on X-ray or CT.
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29
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Abdominal aortic calcification is associated with a higher risk of injurious fall-related hospitalizations in older Australian women. Atherosclerosis 2021; 328:153-159. [PMID: 34120736 DOI: 10.1016/j.atherosclerosis.2021.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/02/2021] [Accepted: 05/07/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUNDS AND AIMS Abdominal aortic calcification (AAC) is associated with weaker grip strength, an established risk factor for fall-related hospitalizations. However, its association with long-term fall-related hospitalisations remains unknown. This study investigated the association between AAC and long-term fall-related hospitalizations in community-dwelling older women. METHODS Fall-related hospitalizations were obtained from linked data over 14.5-years in a prospective cohort of 1053 older women (mean age 75.0 ± 2.6 years). At baseline (1998/99), AAC was assessed from lateral spine images obtained using dual-energy X-ray absorptiometry, and scored using a semi-quantitative method (AAC24, range 0-24). The presence of any AAC was defined by AAC24 ≥ 1. RESULTS Over 14.5-years, 413 (39.2%) women experienced a fall-related hospitalization. In the multivariable-adjusted model, each unit increase in baseline AAC24 was associated with a 3% increase in relative hazards for a fall-related hospitalization (HR 1.03 95%CI, 1.01 to 1.07). Compared to women with no AAC, women with any AAC had a 40% (HR 1.40 95%CI, 1.11 to 1.76) and 39% (HR 1.39 95%CI, 1.10 to 1.76) greater risk for fall-related hospitalizations in the minimal and multivariable-adjusted models, respectively. This relationship was not attenuated by including measures of muscle function such as grip strength and timed-up-and-go. CONCLUSIONS The presence of AAC is associated with long-term fall-related hospitalizations risk, independent of muscle function, in community-dwelling older women. Concurrent assessment of AAC may be a simple and cost-effective way to identify older women at higher risk of falling as part of routine osteoporosis screening.
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Schousboe JT, Langsetmo L, Szulc P, Lewis JR, Taylor BC, Kats AM, Vo TN, Ensrud KE. Joint Associations of Prevalent Radiographic Vertebral Fracture and Abdominal Aortic Calcification With Incident Hip, Major Osteoporotic, and Clinical Vertebral Fractures. J Bone Miner Res 2021; 36:892-900. [PMID: 33729640 PMCID: PMC8131243 DOI: 10.1002/jbmr.4257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/12/2021] [Accepted: 01/20/2021] [Indexed: 01/11/2023]
Abstract
Prevalent vertebral fractures (PVFx) and abdominal aortic calcification (AAC) are both associated with incident fractures and can be ascertained on the same lateral spine images, but their joint association with incident fractures is unclear. Our objective was to estimate the individual and joint associations of PVFx and AAC with incident major osteoporotic, hip, and clinical vertebral fractures in 5365 older men enrolled in the Osteoporotic Fractures in Men (MrOS) Study, using Cox proportional hazards and Fine and Gray subdistribution hazards models to account for competing mortality. PVFx (Genant SQ grade 2 or 3) and 24-point AAC score were ascertained on baseline lateral spine radiographs. Self-reports of incident fractures were solicited every 4 months and confirmed by review of clinical radiographic reports. Compared with men without PVFx and AAC-24 score 0 or 1, the subdistribution hazard ratio (SHR) for incident major osteoporotic fracture was 1.38 (95% confidence interval [CI] 1.13-1.69) among men with AAC-24 score ≥2 alone, 1.71 (95% CI 1.37-2.14) for men with PVFx alone, and 2.35 (95% CI 1.75-3.16) for men with both risk factors, after accounting for conventional risk factors and competing mortality. Wald statistics showed improved prediction model performance by including both risk factors compared with including only AAC (chi-square = 17.3, p < .001) or including only PVFx (chi-square = 8.5, p = .036). Older men with both PVFx and a high level of AAC are at higher risk of incident major osteoporotic fracture than men with either risk factor alone. Assessing prevalent radiographic vertebral fracture and AAC on the same lateral spine images may improve prediction of older men who will have an incident major osteoporotic fracture, even after accounting for traditional fracture risk factors and competing mortality. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, Bloomington, MN, USA.,University of Minnesota, Minneapolis, MN, USA
| | | | - Pawel Szulc
- INSERM UMR 1033, University of Lyon, Lyon, France
| | - Joshua R Lewis
- Edith Cowan University, Perth, Australia.,University of Western Australia, Perth, Australia
| | - Brent C Taylor
- University of Minnesota, Minneapolis, MN, USA.,Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, MN, USA
| | | | - Tien N Vo
- University of Minnesota, Minneapolis, MN, USA
| | - Kristine E Ensrud
- University of Minnesota, Minneapolis, MN, USA.,Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, MN, USA
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31
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Mace ML, Gravesen E, Nordholm A, Egstrand S, Morevati M, Nielsen C, Kjaer A, Behets G, D'Haese P, Olgaard K, Lewin E. Chronic Kidney Disease-Induced Vascular Calcification Impairs Bone Metabolism. J Bone Miner Res 2021; 36:510-522. [PMID: 33301619 PMCID: PMC7988613 DOI: 10.1002/jbmr.4203] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 12/31/2022]
Abstract
An association between lower bone mineral density (BMD) and presence of vascular calcification (VC) has been reported in several studies. Chronic kidney disease (CKD) causes detrimental disturbances in the mineral balance, bone turnover, and development of severe VC. Our group has previously demonstrated expression of Wnt inhibitors in calcified arteries of CKD rats. Therefore, we hypothesized that the CKD-induced VC via this pathway signals to bone and induces bone loss. To address this novel hypothesis, we developed a new animal model using isogenic aorta transplantation (ATx). Severely calcified aortas from uremic rats were transplanted into healthy rats (uremic ATx). Transplantation of normal aortas into healthy rats (normal ATx) and age-matched rats (control) served as control groups. Trabecular tissue mineral density, as measured by μCT, was significantly lower in uremic ATx rats compared with both control groups. Uremic ATx rats showed a significant upregulation of the mineralization inhibitors osteopontin and progressive ankylosis protein homolog in bone. In addition, we found significant changes in bone mRNA levels of several genes related to extracellular matrix, bone turnover, and Wnt signaling in uremic ATx rats, with no difference between normal ATx and control. The bone histomorphometry analysis showed significant lower osteoid area in uremic ATx compared with normal ATx along with a trend toward fewer osteoblasts as well as more osteoclasts in the erosion lacunae. Uremic ATx and normal ATx had similar trabecular number and thickness. The bone formation rate did not differ between the three groups. Plasma biochemistry, including sclerostin, kidney, and mineral parameters, were similar between all three groups. ex vivo cultures of aorta from uremic rats showed high secretion of the Wnt inhibitor sclerostin. In conclusion, the presence of VC lowers BMD, impairs bone metabolism, and affects several pathways in bone. The present results prove the existence of a vasculature to bone tissue cross-talk. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Maria L Mace
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Eva Gravesen
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Nordholm
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Nephrology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Soeren Egstrand
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Nephrology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Marya Morevati
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Nielsen
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Geert Behets
- Department of Biomedical Sciences, Laboratory of Pathophysiology, University of Antwerp, Antwerp, Belgium
| | - Patrick D'Haese
- Department of Biomedical Sciences, Laboratory of Pathophysiology, University of Antwerp, Antwerp, Belgium
| | - Klaus Olgaard
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ewa Lewin
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Nephrology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
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32
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Tsai YT, Yeh HY, Chao CT, Chiang CK. Superoxide Dismutase 2 (SOD2) in Vascular Calcification: A Focus on Vascular Smooth Muscle Cells, Calcification Pathogenesis, and Therapeutic Strategies. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6675548. [PMID: 33728027 PMCID: PMC7935587 DOI: 10.1155/2021/6675548] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/27/2021] [Accepted: 02/10/2021] [Indexed: 12/11/2022]
Abstract
Vascular calcification (VC) describes the pathophysiological phenotype of calcium apatite deposition within the vascular wall, leading to vascular stiffening and the loss of compliance. VC is never benign; the presence and severity of VC correlate closely with the risk of myocardial events and cardiovascular mortality in multiple at-risk populations such as patients with diabetes and chronic kidney disease. Mitochondrial dysfunction involving each of vascular wall constituents (endothelia and vascular smooth muscle cells (VSMCs)) aggravates various vascular pathologies, including atherosclerosis and VC. However, few studies address the pathogenic role of mitochondrial dysfunction during the course of VC, and mitochondrial reactive oxygen species (ROS) seem to lie in the pathophysiologic epicenter. Superoxide dismutase 2 (SOD2), through its preferential localization to the mitochondria, stands at the forefront against mitochondrial ROS in VSMCs and thus potentially modifies the probability of VC initiation or progression. In this review, we will provide a literature-based summary regarding the relationship between SOD2 and VC in the context of VSMCs. Apart from the conventional wisdom of attenuating mitochondrial ROS, SOD2 has been found to affect mitophagy and the formation of the autophagosome, suppress JAK/STAT as well as PI3K/Akt signaling, and retard vascular senescence, all of which underlie the beneficial influences on VC exerted by SOD2. More importantly, we outline the therapeutic potential of a novel SOD2-targeted strategy for the treatment of VC, including an ever-expanding list of pharmaceuticals and natural compounds. It is expected that VSMC SOD2 will become an important druggable target for treating VC in the future.
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Affiliation(s)
- You-Tien Tsai
- 1Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
| | - Hsiang-Yuan Yeh
- 2School of Big Data Management, Soochow University, Taipei, Taiwan
| | - Chia-Ter Chao
- 1Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
- 3Nephrology Division, Department of Internal Medicine, National Taiwan University School of Medicine, Taipei, Taiwan
- 4Graduate Institute of Toxicology, National Taiwan University School of Medicine, Taipei, Taiwan
| | - Chih-Kang Chiang
- 4Graduate Institute of Toxicology, National Taiwan University School of Medicine, Taipei, Taiwan
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Yu C, Zhang C, Kuang Z, Zheng Q. The Role of NLRP3 Inflammasome Activities in Bone Diseases and Vascular Calcification. Inflammation 2020; 44:434-449. [PMID: 33215255 PMCID: PMC7985100 DOI: 10.1007/s10753-020-01357-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/24/2020] [Accepted: 10/02/2020] [Indexed: 02/07/2023]
Abstract
Continuous stimulation of inflammation is harmful to tissues of an organism. Inflammatory mediators not only have an effect on metabolic and inflammatory bone diseases but also have an adverse effect on certain genetic and periodontal diseases associated with bone destruction. Inflammatory factors promote vascular calcification in various diseases. Vascular calcification is a pathological process similar to bone development, and vascular diseases play an important role in the loss of bone homeostasis. The NLRP3 inflammasome is an essential component of the natural immune system. It can recognize pathogen-related molecular patterns or host-derived dangerous signaling molecules, recruit, and activate the pro-inflammatory protease caspase-1. Activated caspase-1 cleaves the precursors of IL-1β and IL-18 to produce corresponding mature cytokines or recognizes and cleaves GSDMD to mediate cell pyroptosis. In this review, we discuss the role of NLRP3 inflammasome in bone diseases and vascular calcification caused by sterile or non-sterile inflammation and explore potential treatments to prevent bone loss.
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Affiliation(s)
- Chenyang Yu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou, 310009, China.,Orthopedics Research Institute of Zhejiang University, No. 88, Jiefang Road, Hangzhou, 310009, China
| | - Caihua Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou, 310009, China.,Orthopedics Research Institute of Zhejiang University, No. 88, Jiefang Road, Hangzhou, 310009, China
| | - Zhihui Kuang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou, 310009, China.,Orthopedics Research Institute of Zhejiang University, No. 88, Jiefang Road, Hangzhou, 310009, China
| | - Qiang Zheng
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou, 310009, China. .,Orthopedics Research Institute of Zhejiang University, No. 88, Jiefang Road, Hangzhou, 310009, China.
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Yokomoto-Umakoshi M, Umakoshi H, Ogata M, Fukumoto T, Matsuda Y, Miyazawa T, Sakamoto R, Ogawa Y. Coexistence of osteoporosis and atherosclerosis in pheochromocytoma: new insights into its long-term management. Osteoporos Int 2020; 31:2151-2160. [PMID: 32617610 DOI: 10.1007/s00198-020-05527-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/26/2020] [Indexed: 02/06/2023]
Abstract
UNLABELLED Osteoporosis and atherosclerosis frequently coexist in patients with pheochromocytoma. The presence of osteoporosis may predict that of atherosclerosis and vice versa in patients with PHEO. These findings have implications for the long-term management of the pheochromocytoma and its potential chronic complications. INTRODUCTION Pheochromocytoma (PHEO), a catecholamine-producing tumor, is often found incidentally, and it may be present for years before it is diagnosed. However, long-term exposure to catecholamines excess may induce chronic complications, such as osteoporosis and atherosclerosis. We aimed to evaluate concomitant osteoporosis and atherosclerosis in patients with PHEO. METHODS Fifty-one patients with PHEO and 51 patients with a non-functional adrenal tumor were compared radiographically for the prevalence of vertebral fracture (VF), a typical osteoporotic fracture, and abdominal aortic calcification (AAC). RESULTS In patients with PHEO, the prevalence of AAC was higher in those with VF (58%) than in those without (6%, p < 0.001). AAC was associated with VF after adjusting for age and sex (odds ratio, 1.53; 95% confidence interval, 1.07-2.46; p = 0.003) in patients with PHEO. The degree of catecholamine excess correlated with the presence of VF and AAC (p = 0.007). The prevalence of VF was higher in patients with PHEO (37%) than those with non-functional AT (12%, p = 0.005), but the prevalence of AAC was comparable between the two groups (25% and 19%, p = 0.636). VF and AAC more frequently coexisted in patients with PHEO (22%) than in those with non-functional AT (2%, p = 0.003). CONCLUSION This study represents the first demonstration that osteoporosis and atherosclerosis frequently coexist in patients with PHEO. The presence of osteoporosis may predict that of atherosclerosis and vice versa in patients with PHEO. These findings have implications for the long-term management of the PHEO and its potential chronic complications.
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Affiliation(s)
- M Yokomoto-Umakoshi
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - H Umakoshi
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - M Ogata
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Fukumoto
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Y Matsuda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Miyazawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - R Sakamoto
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Y Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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35
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Mazziotti G, Tupputi U, Ferrante G, Guglielmi G. Abdominal Aortic Calcification as a Marker of Relationship Between Atherosclerosis and Skeletal Fragility. J Clin Densitom 2020; 23:539-542. [PMID: 32536435 DOI: 10.1016/j.jocd.2020.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/22/2020] [Accepted: 05/05/2020] [Indexed: 11/21/2022]
Abstract
There is a pathophysiological and clinical link between atherosclerosis and skeletal fragility. Abdominal aortic calcifications (AACs) can be considered as a marker of coexistent atherosclerotic disease and osteoporosis. Indeed, AACs have been associated with alterations in bone strength and severe AACs predicted vertebral fractures in post-menopausal women and older men, independent of densitometric diagnosis of osteoporosis. Although quantitative computed tomography is the gold standard for evaluation of AACs, dual-energy x-ray absorptiometry can be considered as a cost-effective tool to identify and quantify AACs in clinical practice. This article provides an update on diagnostic aspects and clinical relevance of AACs as predictor of fractures in patients at high cardiovascular risk.
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Affiliation(s)
- G Mazziotti
- Endocrinology, Diabetology and Andrology Unit, Osteoporosis and Metabolic Bone Diseases Section, Humanitas Clinical and Research Center, IRCCS, Rozzano (Milan), Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - U Tupputi
- Department of Radiology, University of Foggia, Foggia, Italy
| | - G Ferrante
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano (Milan), Italy
| | - G Guglielmi
- Department of Radiology, University of Foggia, Foggia, Italy; Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy.
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Abstract
PURPOSE OF REVIEW We summarize recent evidence on the shared genetics within and outside the musculoskeletal system (mostly related to bone density and osteoporosis). RECENT FINDINGS Osteoporosis is determined by an interplay between multiple genetic and environmental factors. Significant progress has been made regarding its genetic background revealing a number of robustly validated loci and respective pathways. However, pleiotropic factors affecting bone and other tissues are not well understood. The analytical methods proposed to test for potential associations between genetic variants and multiple phenotypes can be applied to bone-related data. A number of recent genetic studies have shown evidence of pleiotropy between bone density and other different phenotypes (traits, conditions, or diseases), within and outside the musculoskeletal system. Power benefits of combining correlated phenotypes, as well as unbiased discovery, make these studies promising. Studies in humans are supported by evidence from animal models. Drug development and repurposing should benefit from the pleiotropic approach. We believe that future studies should take into account shared genetics between the bone and related traits.
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Affiliation(s)
- M A Christou
- Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - E E Ntzani
- Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
- Center for Research Synthesis in Health, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - D Karasik
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
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37
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Iribarren C, Chandra M, Molloi S, Sam D, Sanchez G, Bidgoli FA, Cho HM, Ding H, Lo JC. No Association Between Bone Mineral Density and Breast Arterial Calcification Among Postmenopausal Women. J Endocr Soc 2020; 4:bvz026. [PMID: 32064410 PMCID: PMC7009123 DOI: 10.1210/jendso/bvz026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/26/2019] [Indexed: 11/19/2022] Open
Abstract
Context The association between bone mineral density (BMD) and breast arterial calcification (BAC) remains poorly understood and controversial. Objective The objective of this article is to examine the association between BMD and BAC in a large cohort of postmenopausal women undergoing routine mammography. Design A cross-sectional analysis of baseline data from a multiethnic cohort was performed. Setting The setting for this analysis is an integrated health care delivery system in Northern California in the United States. Patients A total of 1273 women age 60 to 79 years (mean age, 67 years) were recruited within 12 months of screening mammography. Main outcome measure A BAC score (mg) was obtained from digital mammograms using a novel densitometry method. BAC presence was defined as a BAC score greater than 0 mg, and severe BAC as a BAC score greater than 20 mg. Results Overall, 53% of women had osteopenia and 21% had osteoporosis. The prevalence of BAC greater than 0 mg was 29%, 30%, and 29% among women with normal BMD, osteopenia, and osteoporosis, respectively (P = 0.98). The prevalence of BAC greater than 20 mg was 5%, 3%, and 5% among women with normal BMD, osteopenia and osteoporosis, respectively (P = .65). The odds ratios (ORs) of BAC greater than 0 mg vs BAC = 0 mg after multivariable adjustment were 1.09 (95% CI, 0.81-1.48; P = .54) for osteopenia and 0.99 (95% CI, 0.69-1.48; P = .98) for osteoporosis. The adjusted ORs for BAC greater than 20 mg vs BAC 20 mg or less were 1.03 (95% CI, 0.52-2.01; P = .93) for osteopenia and 1.89 (95 CI, 0.81-4.47; P = .14) for osteoporosis. Conclusion Our findings do not support an association of either osteopenia or osteoporosis with BAC presence or severity among postmenopausal women.
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Affiliation(s)
| | - Malini Chandra
- Kaiser Permanente Division of Research, Oakland, California
| | - Sabee Molloi
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, California
| | - Danny Sam
- Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | | | - Fatemeh Azamian Bidgoli
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, California
| | - Hyo-Min Cho
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, California
| | - Huanjun Ding
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, California
| | - Joan C Lo
- Kaiser Permanente Division of Research, Oakland, California.,Kaiser Permanente Oakland Medical Center, Oakland, California
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38
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Abstract
The phenotypic trait of high bone mass (HBM) is an excellent example of the nexus between common and rare disease genetics. HBM may arise from carriage of many 'high bone mineral density [BMD]'-associated alleles, and certainly the genetic architecture of individuals with HBM is enriched with high BMD variants identified through genome-wide association studies of BMD. HBM may also arise as a monogenic skeletal disorder, due to abnormalities in bone formation, bone resorption, and/or bone turnover. Individuals with monogenic disorders of HBM usually, though not invariably, have other skeletal abnormalities (such as mandible enlargement) and thus are best regarded as having a skeletal dysplasia rather than just isolated high BMD. A binary etiological division of HBM into polygenic vs. monogenic, however, would be excessively simplistic: the phenotype of individuals carrying rare variants of large effect can still be modified by their common variant polygenic background, and by the environment. HBM disorders-whether predominantly polygenic or monogenic in origin-are not only interesting clinically and genetically: they provide insights into bone processes that can be exploited therapeutically, with benefits both for individuals with these rare bone disorders and importantly for the many people affected by the commonest bone disease worldwide-i.e., osteoporosis. In this review we detail the genetic architecture of HBM; we provide a conceptual framework for considering HBM in the clinical context; and we discuss monogenic and polygenic causes of HBM with particular emphasis on anabolic causes of HBM.
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Affiliation(s)
- Celia L. Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- *Correspondence: Celia L. Gregson, ; Emma L. Duncan,
| | - Emma L. Duncan
- Department of Twin Research & Genetic Epidemiology, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- *Correspondence: Celia L. Gregson, ; Emma L. Duncan,
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