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. 2021 Oct 12;13(10):3567.
doi: 10.3390/nu13103567.

The Vessels-Bone Axis: Iliac Artery Calcifications, Vertebral Fractures and Vitamin K from VIKI Study

Maria Fusaro  1   2 , Giovanni Tripepi  3 , Mario Plebani  4 , Cristina Politi  3 , Andrea Aghi  5 , Fulvia Taddei  6 , Enrico Schileo  6 , Martina Zaninotto  4 , Gaetano La Manna  7 , Giuseppe Cianciolo  7 , Maurizio Gallieni  8 , Laura Cosmai  9 , Piergiorgio Messa  10   11 , Maura Ravera  12 , Thomas L Nickolas  13 , Serge Ferrari  14 , Markus Ketteler  15 , Giorgio Iervasi  2 , Maria Cristina Mereu  16 , Roberto Vettor  2 , Sandro Giannini  5 , Lorenzo Gasperoni  7 , Stefania Sella  5 , Maria Luisa Brandi  17 , Luisella Cianferotti  17 , Raffaele De Caterina  18   19
Affiliations

The Vessels-Bone Axis: Iliac Artery Calcifications, Vertebral Fractures and Vitamin K from VIKI Study

Maria Fusaro et al. Nutrients. .

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.

Keywords: epidemiology; metabolic syndrome; peripheral vascular disease; vitamin K.

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Conflict of interest statement

The authors declare no conflict of interest as to the study content.

Figures

Figure 1
Figure 1
Proportion of patients with abdominal aorta calcifications (AACs) and frequency of AACs degree severity according to iliac arteries calcifications (IACs) presence (YES/NO). The prevalence of AACs as well as of severe AACs was significantly higher (p < 0.001) in patients with IACs than without.
Figure 2
Figure 2
Proportion of patients with iliac arteries calcifications (IACs) and frequency of IACs degree severity.
Figure 3
Figure 3
Levels of MK7 (A) and of MK7/Triglycerides (B) in hemodialysis patients with and without iliac artery calcifications (IACs). Data are presented as median 25th/75th percentiles and maximum/minimum recorded values. p-Values indicate statistically significant differences between patients with IACs compared to without. * Extreme value marked with star.
Figure 4
Figure 4
Iliac arteries calcifications (IACs) were associated in this study with 73% higher odds of VF (p = 0.028) whereas AACs were not (p = 0.294). Patients with IACs had lower levels of the vitamin K2, MK7 (0.99 vs. 1.15 ng/mL; p = 0.003).
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