Relationship between bone mineral density and serum osteoprotegerin in patients with chronic heart failure

Abstract

Purpose: Heart failure (HF) had been reported with increased risk of hip fractures. However, the relationship between circulating biomarkers and bone mineral density (BMD) in chronic HF remained unclear.

Methods: This is a cross-sectional study which recruited stable chronic HF from registry of the Heart Failure Center of National Taiwan University Hospital. Patients underwent dual-energy x-ray absorptiometry (DEXA) measurements at hip and lumbar spines and biochemical assessments including B-type natriuretic peptide (BNP-32), myostatin, follistatin and osteoprotegerin (OPG).

Results: A total of 115 stable chronic HF individuals with left ventricular ejection fraction (EF) <45% (74% of male, mean age at 59) were recruited with 24 patients in NYHA class I, 73 patients in NYHA class II and 18 patients in NYHA class III. Results of BMD showed that Z scores of hip in NYHA III group (-0.12 ± 1.15) was significantly lower than who were NYHA II (0.58 ± 1.04). Serum OPG was significantly higher in subjects of NYHA III (9.3 ± 4.6 pmol/l) than NYHA II (7.4 ± 2.8 pmol/l) or NYHA I (6.8 ± 3.6 pmol/l) groups. There's a significant negative association between log transformed serum OPG and trochanteric BMD (R = -0.299, P = 0.001), which remained significant after multivariate analysis.

Conclusions: Our study demonstrated an inverse association between serum OPG and trochanteric BMD in patients with HF. OPG may be a predictor of BMD and an alternative to DEXA for identifying at risk HF patients for osteoporosis.

Figure 1. Heart failure related biomarker in different NYHA functional classes.

FS: follistatin, MS: myostatin, BNP-32: Brain natriuretic peptide 32, CRP: high sensitivity C reactive protein, OPG: osteoprotegerin, †: p<0.05.

Figure 2. Hip and lumbar Z-score in different NYHA functional classes.

A significant difference of hip Z-score was observed between NYHA functional class II and III, †: p<0.05.