Cigarette smoking is associated with decreased Bone Gla-protein (BGP) levels in hemodialysis patients

Maria Fusaro, Maurizio Gallieni, Andrea Aghi, Giorgio Iervasi, Maria Antonietta Rizzo, Andrea Stucchi, Marianna Noale, Giovanni Tripepi, Thomas Nickolas, Nicola Veronese, Fabrizio Fabris, Sandro Giannini, Lorenzo Calò, Antonio Piccoli, Maria Cristina Mereu, Laura Cosmai, Alberto Ferraro, Fiorenza Magonara, Michela Spinello, Stefania SellaMario Plebani

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Bone gamma-carboxyglutamic acid (Gla)-protein (BGP or osteocalcin) is a vitamin K-dependent protein involved in the regulation of bone mineralization. Smoking is a risk factor for osteoporosis.

METHODS: We carried out a secondary analysis of the vitamin K Italian (VIKI) study to investigate the association between cigarette smoking and BGP levels in patients with end stage renal disease. Data were collected in 370 haemodialysis patients, 37% (136) smokers (or ex-smokers) and 63% (234) non-smokers. Vascular calcifications and vertebral fractures (quantitative morphometry) were identified on spine radiographs.

RESULTS: Smokers had significantly lower BGP levels (152 vs 204 μg/L, p= 0.003). Smokers had lower plasma phosphate levels (4.2 vs 4.7 mg/dl, p<0.01). Lower BGP levels were associated with aortic calcification (p<0.001), iliac calcification (p=0.042) and vertebral fractures (p=0.023). In addition, the regression model showed that smoking is associated with a significant reduction of total BGP levels by about 18% (p=0.01).

CONCLUSION: This is the first clinical study in a haemodialysis population, which identifies cigarette smoking as a potential factor that can lower BGP levels, a protective agent in bone and vascular health.

Original languageEnglish
JournalCurrent Vascular Pharmacology
Publication statusE-pub ahead of print - Sep 19 2017


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