The following is a summary of “Midregional Proatrial Natriuretic Peptide (MRproANP) is associated with vertebral fractures and low bone density in patients with chronic obstructive pulmonary disease (COPD),” published in the July 2024 issue of Pulmonology by Trudzinski, et al.

Patients with COPD often suffer from decreased bone mineral density (BMD) and a heightened risk of osteoporotic fractures. While natriuretic peptides (NPs) are established cardiac biomarkers, they have also been implicated in fragility-related fractures in elderly populations. Given their role in regulating fluid and mineral balance, NPs may significantly influence bone metabolism, especially in systemic disorders like COPD.

This study aimed to explore the association between NP serum levels, vertebral fractures, and BMD assessed via chest computed tomography (CT) in patients with COPD

The study included participants from the COSYCONET cohort who had undergone CT scans. Vertebral bone density on CT (BMD-CT) was assessed at the level of TH12 using AI-Rad Companion, and vertebral compression fractures were visually quantified by 2 independent readers. The relationships between N-terminal pro-B-type natriuretic peptide (NT-proBNP), MRproANP, Midregional pro-adrenomedullin (MRproADM), and bone metrics were analyzed through group comparisons and multivariable analyses.

Among the 418 participants (58% male, median age 64 years, FEV1 59.6% predicted), vertebral fractures at TH12 were identified in 76 patients (18.1%). Those with fractures exhibited significantly higher serum levels of MRproANP and MRproADM (p ≤ 0.005) compared to those without fractures. Multivariable logistic regression analyses, adjusted for factors including sex, BMI, smoking status, FEV1% predicted, SGRQ Activity score, daily physical activity, oral corticosteroid use, cardiac disease, and renal impairment, identified MRproANP levels ≥ 65 nmol/l (OR 2.34; P= 0.011) and age (P= 0.009) as significant predictors of fractures. Similarly, MRproANP (p < 0.001), age (P= 0.055), SGRQ Activity score (P= 0.061), and active smoking (P= 0.025) were linked to TH12 vertebral density.

MRproANP emerged as a marker for osteoporotic vertebral fractures in patients with COPD from the COSYCONET cohort. Its correlation with reduced vertebral BMD on CT, alongside its known effects on fluid and ion balance, suggests a potential direct impact on bone mineralization. These findings underscore the relevance of MRproANP in the context of bone health in patients with COPD highlighting its potential as a predictive biomarker for osteoporotic fractures and diminished bone density.

Source: respiratory-research.biomedcentral.com/articles/10.1186/s12931-024-02902-2