Midregional Proatrial Natriuretic Peptide (MRproANP) is Associated with Vertebral Fractures and Low Bone Density in Patients with Chronic Obstructive Pulmonary Disease (COPD)

Overview

Journal Respir Res

Specialty Pulmonary Medicine

Date 2024 Jul 13

PMID 39003487

Authors

Franziska C Trudzinski

Rudolf A Jorres

Peter Alter

Henrik Watz

Claus F Vogelmeier

Hans-Ulrich Kauczor

Subasini Thangamani

Manuel Debic

Tobias Welte

Jurgen Behr

Kathrin Kahnert

Robert Bals

Christian Herr

Claus Peter Heussel

Jurgen Biederer

Oyunbileg von Stackelberg

Sebastian Fahndrich

Emiel F M Wouters

Benjamin Waschki

Klaus F Rabe

Felix J F Herth

Viktoria Palm

Affiliations

Soon will be listed here.

Abstract

Background: Patients with COPD are often affected by loss of bone mineral density (BMD) and osteoporotic fractures. Natriuretic peptides (NP) are known as cardiac markers, but have also been linked to fragility-associated fractures in the elderly. As their functions include regulation of fluid and mineral balance, they also might affect bone metabolism, particularly in systemic disorders such as COPD.

Research Question: We investigated the association between NP serum levels, vertebral fractures and BMD assessed by chest computed tomography (CT) in patients with COPD.

Methods: Participants of the COSYCONET cohort with CT scans were included. Mean vertebral bone density on CT (BMD-CT) as a risk factor for osteoporosis was assessed at the level of TH12 (AI-Rad Companion), and vertebral compression fractures were visually quantified by two readers. Their relationship with N-terminal pro-B-type natriuretic peptide (NT-proBNP), Mid-regional pro-atrial natriuretic peptide (MRproANP) and Midregional pro-adrenomedullin (MRproADM) was determined using group comparisons and multivariable analyses.

Results: Among 418 participants (58% male, median age 64 years, FEV 59.6% predicted), vertebral fractures in TH12 were found in 76 patients (18.1%). Compared to patients without fractures, these had elevated serum levels (p ≤ 0.005) of MRproANP and MRproADM. Using optimal cut-off values in multiple logistic regression analyses, MRproANP levels ≥ 65 nmol/l (OR 2.34; p = 0.011) and age (p = 0.009) were the only significant predictors of fractures after adjustment for sex, BMI, smoking status, FEV% predicted, SGRQ Activity score, daily physical activity, oral corticosteroids, the diagnosis of cardiac disease, and renal impairment. Correspondingly, MRproANP (p < 0.001), age (p = 0.055), SGRQ Activity score (p = 0.061) and active smoking (p = 0.025) were associated with TH12 vertebral density.

Interpretation: MRproANP was a marker for osteoporotic vertebral fractures in our COPD patients from the COSYCONET cohort. Its association with reduced vertebral BMD on CT and its known modulating effects on fluid and ion balance are suggestive of direct effects on bone mineralization.

Trial Registration: ClinicalTrials.gov NCT01245933, Date of registration: 18 November 2010.

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