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Updated: May 14, 2026
Calcification of Vascular Smooth Muscle Cells and Imaging of Aortic Calcification and Inflammation
Published on: May 31, 2016
Exploring the bone-vascular axis: AI-augmented chest CT analysis in COPD highlights association between vertebral
Viktoria Palm1, Andreas Wagner2, Ondrej Havlicek2
1Department of Diagnostic and Interventional Radiology (DIR), University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg University, Heidelberg, Germany; Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik Heidelberg, Heidelberg, Germany.
Reduced bone mineral density (BMD) is linked to increased vascular calcification in chronic obstructive pulmonary disease (COPD) patients, regardless of disease severity. Inhaled corticosteroid (ICS) use showed a minor association with coronary artery calcification (CAC).
Area of Science:
- Radiology and Imaging
- Pulmonology
- Gerontology
- Biomedical Engineering
Background:
- Artificial intelligence (AI) enables automated CT scan analysis for bone mineral density (BMD) and vascular calcification (coronary artery calcification [CAC] and aortic calcification).
- Chronic obstructive pulmonary disease (COPD) patients exhibit multimorbidity, including potential links between bone and vascular health.
- The 'bone-vascular axis' describes the relationship between decreased bone density and increased vascular calcification.
Purpose of the Study:
- To investigate the association between vertebral bone mineral density (BMD) and vascular calcification (CAC and total thoracic calcification [TTC]) in COPD patients.
- To examine the influence of COPD severity (GOLD stages) and inhaled corticosteroid (ICS) use on the bone-vascular axis.
- To leverage AI tools for quantitative assessment of BMD and calcification on low-dose chest CT scans.
Main Methods:
- Analysis of low-dose chest CT scans from 540 COSYCONET study participants using AI-based tools.
- Quantification of vertebral BMD (T12 Hounsfield units), CAC, aortic calcification, and total thoracic calcification (TTC).
- Stratified correlation and multivariable/interaction analyses based on COPD severity (GOLD 0-2 vs. GOLD 3-4) and ICS treatment.
Main Results:
- Decreased vertebral BMD was consistently and inversely correlated with both CAC and TTC (ρ ≈ -0.25 to -0.30), irrespective of COPD severity.
- Higher CAC and TTC were associated with older age, smoking, higher BMI, and poorer physical function.
- A marginally significant trend suggested a stronger association between ICS use and CAC (β = -0.175, p = 0.042), but no significant effect for TTC.
Conclusions:
- Reduced vertebral BMD is associated with increased vascular calcification in COPD patients, supporting the 'bone-vascular axis' concept.
- This relationship appears largely independent of COPD severity, suggesting shared underlying degenerative pathways.
- Inhaled corticosteroid (ICS) therapy may have a marginal influence on the association between BMD and CAC.
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