The Important Role of Osteoprotegerin in the Relationship between Vascular Calcification and Osteoporosis_West China Medical Journal

Authors：

 ZHAOCai-xia ¹ ,  ZHANGXu ¹ , CAOJuan ¹ , LIHai-tao ¹ , XUQin ¹ , YINDi ¹ , ZHOUChang-ju ¹ , GAOYong-mei ²

1. Department of Nephrology, Taixing People's Hospital, Taixing, Jiangsu 225400, P. R. China;
2. Operating Room, People's Hospital of Yishui County, Yishui, Shandong 276400, P. R. China;

Corresponding?author：

ZHANGXu, Email: dr.zhangxu@tom.com

Keywords：

Maintenance hemodialysis; Osteoprotegerin; Vascular calcifi cation; Bone mineral density

DOI：

10.7507/1002-0179.20140375

Video：

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Objective To investigate the relationship among bone density, osteoprotegerin (OPG) and vascular calcification (VC) in maintenance hemodialysis (MHD) patients. Methods One hundred MHD patients were collected from our department between May 2010 and December 2012. The VC was detected by plain radiographs. Bone mineral density was measured with dual-energy X-ray absorptionmeter. The level of serum OPG was measured by enzymelinked immunosorbent assay. Other clinically related indicators were also detected. The related parameters were examined statistically. Results The incidence of VC in MHD patients was 74% (74/100), and the OPG level significantly increased with the degree of vascular calcification (P<0.05). The proportion of patients with normal bone volume was 40%, and with abnormal bone volume was 60%. Compared with patients with normal bone volume, the patients with abnormal bone volume had higher serum OPG level (P<0.05). The patients with no VC had a lower incidence of abnormal bone volume than patients with VC (P<0.05). Multiple linear regression analysis revealed that vascular calcification score, OPG level and age were independent factors for bone mineral density. Dialysis time, OPG level, serum albumin level and bone mineral density were independent factors for vascular calcification score. Conclusion The MHD patients with vascular calcification are often associated with osteoporosis at the same time. OPG plays an important role in the relationship between vascular calcification and osteoporosis.

Citation： ZHAOCai-xia, ZHANGXu, CAOJuan, LIHai-tao, XUQin, YINDi, ZHOUChang-ju, GAOYong-mei. The Important Role of Osteoprotegerin in the Relationship between Vascular Calcification and Osteoporosis. West China Medical Journal, 2014, 29(7): 1220-1223. doi: 10.7507/1002-0179.20140375 Copy

1.	Aoki A, Kojima F, Uchida K, et al. Associations between vascular calcification, arterial stiffness and bone mineral density in chronic hemodialysis patients[J]. Geriatr Gerontol Int, 2009, 9(3):246-252.
2.	Adragao T, Herberth J, Monier-Faugere MC, et al. Low bone volume--a risk factor for coronary calcifications in hemodialysis patients[J]. Clin J Am Soc Nephrol, 2009, 4(2):450-455.
3.	Aoyagi K, Ross PD, Orloff J, et al. Low bone density is not associated with aortic calcification[J]. Calcif Tissue Int, 2001, 69(1):20-24.
4.	Bucay N, Sarosi I, Dunstan CR, et al. Osteoprotegerin-deficient mice develop early onset osteoporosis and arterial calcification[J]. Genes Dev, 1998, 12(9):1260-1268.
5.	Adragao T, Pires A, Lucas C, et al. A simple vascular calcification score predicts cardiovascular risk in haemodialysis patients[J]. Nephrol Dial Transplant, 2004, 19(6):1480-1488.
6.	Simonet WS, Lacey DL, Dunstan CR, et al. Osteoprotegerin:a novel secreted protein involved in the regulation of bone density[J]. Cell, 1997, 89(2):309-319.
7.	Tousoulis D, Siasos G, Maniatis K, et al. Novel biomarkers assessing the calcium deposition in coronary artery disease[J]. Curr Med Chem, 2012, 19(6):901-920.
8.	Gilmore TD. Introduction to NF-kappaB:players, pathways, perspectives[J]. Oncogene, 2006, 25(51):6680-6684.
9.	Bekker PJ, Holloway D, Nakanishi A, et al. The effect of a single dose of osteoprotegerin in postmenopausal women[J]. J Bone Miner Res, 2001, 16(2):348-360.
10.	袁瑞麗, 劉鋼. 骨保護素與類風濕性關節炎[J]. 華西醫學, 2008, 23(3):653-654.
11.	林珊, 李莉娜, 鄭振峰, 等. 血液透析患者骨密度與骨保護素和核因子κB受體活化因子配體的關系[J]. 中華腎臟病雜志, 2008, 24(1):58-59.
12.	Panizo S, Cardus A, Encinas M, et al. RANKL increases vascular smooth muscle cell calcification through a RANK-BMP4-dependent pathway[J]. Circ Res, 2009, 104(9):1041-1048.
13.	Ren MY, Sui SJ, Zhang Y, et al. Increased plasma osteoprotegerin levels are associated with the presence and severity of acute coronary syndrome[J]. Acta Cardiol, 2008, 63(5):615-622.
14.	Kurnatowska I, Grzelak P, Kaczmarska M, et al. Serum osteoprotegerin is a predictor of progression of atherosclerosis and coronary calcification in hemodialysis patients[J]. Nephron Clin Pract, 2011, 117(4):c297-c304.
15.	Mesquita M, Demulder A, Damry N, et al. Plasma osteoprotegerin is an independent risk factor for mortality and an early biomarker of coronary vascular calcification in chronic kidney disease[J]. Clin Chem Lab Med, 2009, 47(3):339-346.
16.	Morena M, Dupuy AM, Jaussent I, et al. A cut-off value of plasma osteoprotegerin level may predict the presence of coronary artery calcifications in chronic kidney disease patients[J]. Nephrol Dial Transplant, 2009, 24(11):3389-3397.
17.	Ford ML, Smith ER, Tomlinson LA, et al. FGF-23 and osteoprotegerin are independently associated with myocardial damage in chronic kidney disease stages 3 and 4. Another link between chronic kidney disease-mineral bone disorder and the heart[J]. Nephrol Dial Transplant, 2012, 27(2):727-733.
18.	Bakhireva LN, Laughlin GA, Bettencourt R, et al. Does osteoprotegerin or receptor activator of nuclear factor-κB ligand mediate the association between bone and coronary artery calcification?[J]. J Clin Endocrinol Metab, 2008, 93(5):2009-2012.
19.	Holden RM, Beseau D, Booth SL, et al. FGF-23 is associated with cardiac troponin T and mortality in hemodialysis patients[J]. Hemodial I nt, 2011, 16(1):53-58.
20.	Kagami S, Ohkido I, Yokoyama K, et al. Osteoprotegerin affects the responsiveness of fibroblast growth factor-23 to high oral phosphate intake[J]. Clin Nephrol, 2008, 70(4):306-311.

1. Aoki A, Kojima F, Uchida K, et al. Associations between vascular calcification, arterial stiffness and bone mineral density in chronic hemodialysis patients[J]. Geriatr Gerontol Int, 2009, 9(3):246-252.
2. Adragao T, Herberth J, Monier-Faugere MC, et al. Low bone volume--a risk factor for coronary calcifications in hemodialysis patients[J]. Clin J Am Soc Nephrol, 2009, 4(2):450-455.
3. Aoyagi K, Ross PD, Orloff J, et al. Low bone density is not associated with aortic calcification[J]. Calcif Tissue Int, 2001, 69(1):20-24.
4. Bucay N, Sarosi I, Dunstan CR, et al. Osteoprotegerin-deficient mice develop early onset osteoporosis and arterial calcification[J]. Genes Dev, 1998, 12(9):1260-1268.
5. Adragao T, Pires A, Lucas C, et al. A simple vascular calcification score predicts cardiovascular risk in haemodialysis patients[J]. Nephrol Dial Transplant, 2004, 19(6):1480-1488.
6. Simonet WS, Lacey DL, Dunstan CR, et al. Osteoprotegerin:a novel secreted protein involved in the regulation of bone density[J]. Cell, 1997, 89(2):309-319.
7. Tousoulis D, Siasos G, Maniatis K, et al. Novel biomarkers assessing the calcium deposition in coronary artery disease[J]. Curr Med Chem, 2012, 19(6):901-920.
8. Gilmore TD. Introduction to NF-kappaB:players, pathways, perspectives[J]. Oncogene, 2006, 25(51):6680-6684.
9. Bekker PJ, Holloway D, Nakanishi A, et al. The effect of a single dose of osteoprotegerin in postmenopausal women[J]. J Bone Miner Res, 2001, 16(2):348-360.
10. 袁瑞麗, 劉鋼. 骨保護素與類風濕性關節炎[J]. 華西醫學, 2008, 23(3):653-654.
11. 林珊, 李莉娜, 鄭振峰, 等. 血液透析患者骨密度與骨保護素和核因子κB受體活化因子配體的關系[J]. 中華腎臟病雜志, 2008, 24(1):58-59.
12. Panizo S, Cardus A, Encinas M, et al. RANKL increases vascular smooth muscle cell calcification through a RANK-BMP4-dependent pathway[J]. Circ Res, 2009, 104(9):1041-1048.
13. Ren MY, Sui SJ, Zhang Y, et al. Increased plasma osteoprotegerin levels are associated with the presence and severity of acute coronary syndrome[J]. Acta Cardiol, 2008, 63(5):615-622.
14. Kurnatowska I, Grzelak P, Kaczmarska M, et al. Serum osteoprotegerin is a predictor of progression of atherosclerosis and coronary calcification in hemodialysis patients[J]. Nephron Clin Pract, 2011, 117(4):c297-c304.
15. Mesquita M, Demulder A, Damry N, et al. Plasma osteoprotegerin is an independent risk factor for mortality and an early biomarker of coronary vascular calcification in chronic kidney disease[J]. Clin Chem Lab Med, 2009, 47(3):339-346.
16. Morena M, Dupuy AM, Jaussent I, et al. A cut-off value of plasma osteoprotegerin level may predict the presence of coronary artery calcifications in chronic kidney disease patients[J]. Nephrol Dial Transplant, 2009, 24(11):3389-3397.
17. Ford ML, Smith ER, Tomlinson LA, et al. FGF-23 and osteoprotegerin are independently associated with myocardial damage in chronic kidney disease stages 3 and 4. Another link between chronic kidney disease-mineral bone disorder and the heart[J]. Nephrol Dial Transplant, 2012, 27(2):727-733.
18. Bakhireva LN, Laughlin GA, Bettencourt R, et al. Does osteoprotegerin or receptor activator of nuclear factor-κB ligand mediate the association between bone and coronary artery calcification?[J]. J Clin Endocrinol Metab, 2008, 93(5):2009-2012.
19. Holden RM, Beseau D, Booth SL, et al. FGF-23 is associated with cardiac troponin T and mortality in hemodialysis patients[J]. Hemodial I nt, 2011, 16(1):53-58.
20. Kagami S, Ohkido I, Yokoyama K, et al. Osteoprotegerin affects the responsiveness of fibroblast growth factor-23 to high oral phosphate intake[J]. Clin Nephrol, 2008, 70(4):306-311.

West China Medical Journal

The Important Role of Osteoprotegerin in the Relationship between Vascular Calcification and Osteoporosis

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