ST2 as a prognostic factor for the development of osteopathic fractures in patients with chronic heart failure and type 2 diabetes mellitus

I n t r o d u c t i o n. Heart failure is a clinical syndrome associated with various metabolic disorders, many of which can adversely aff ect the musculoskeletal system. Pro-infl ammatory cytokines, playing an important role in the pathogenesis of chronic heart failure (CHF), can also alter bone metabolism.

A i m. To study the prognostic signifi cance of soluble ST2 as a biomarker of bone mineral density (BMD) decline progression and the risk of osteoporotic fractures in patients with CHF and type 2 diabetes mellitus (T2DM).

M a t e r i a l s  a n d  m e t h o d s. A 12-month prospective, clinically controlled study of 75 women with CHF and T2DM was conducted. Bone tissue characteristics were analyzed taking into account ST2 levels in 3 tertiles. The selective sample of the 1st tertile (n = 25) included patients with a minimum ST2 level of less than 21,3 ng/ml; in the 2nd tertile (n = 25) – patients with an ST2 level of 21,3–32,8 ng/ml; in the 3rd tertile (n = 25) – patients with a ST2 level is over 32,8 ng/ml. ST2 concentration was determined by enzyme immunoassay. BMD was assessed using the densitometric method using dual energy X-ray absorptiometry (DXA).

R e s u l t s. After 12 months, the frequency of the combined endpoint was assessed: a decrease in BMD according to DXA and/or development of osteoporotic fractures. The frequency of adverse events gradually increased from the 1st tertile to the 3rd tertile (p = 0,001). In women with comorbidities having a median ST2 of over 25,3 ng/ml and BMD (according to T-score) of less than –2,5, the highest frequency (52,6%) of adverse osteoporotic events was identifi ed. There was a moderate negative correlation of ST2 levels with BMD (r = –0,48; p = 0,001).

C o n c l u s i o n. Elevated ST2 levels are associated with the progression of BMD loss and the risk of osteoporotic fractures. It seems appropriate and informative to study the serum level of ST2 in women with CHF and T2DM to assess the risk of osteoporotic fractures.

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