{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:07:29Z","timestamp":1789380449895,"version":"build-2803163510"},"reference-count":55,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to investigate the effect of body composition on the inverse relationship between vertebral bone density (T12 BMD) and total thoracic vascular calcification (TTVC) in patients with chronic obstructive pulmonary disease (COPD). Moreover, we aimed to assess whether intermuscular adipose tissue (IMAT) affects the bone-vascular axis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Chest CT scans of 539 COPD patients from the multicentric prospective COSYCONET study were retrospectively analyzed using AI-based tools for T12 BMD, TTVC, and volumetric body composition. Multivariable linear regression models were built to investigate the effect of conventional body phenotypes (normal, sarcopenic, non-sarcopenic obesity, and sarcopenic obesity). Stepwise interaction model building included T12 BMD, IMAT, their interaction, adding BMI, clinical and metabolic covariates, lung function, physical performance, and age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The T12 BMD showed a consistent inverse association with TTVC in all phenotypes, with \u03b2\u2009=\u2009\u22120.38 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) in normal nutritional status, \u03b2\u2009=\u2009\u22120.36 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) in sarcopenia, and \u03b2\u2009=\u2009\u22120.24 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) in non-sarcopenic obesity. However, the phenotype\u2019s significant effect was not confirmed in the interaction model. Age and pack-years were associated with calcification, but IMAT remained independently associated (\u03b2\u2009=\u20090.15, 95% CI 0.015\u20130.28,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.029), while the interaction between T12 BMD and IMAT lost significance once age was included.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>IMAT index was independently associated with TTVC in COPD. The modifying effect of IMAT on the bone-vascular axis was most evident in models without age adjustment, suggesting that the observed interaction may be influenced by age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>The interactions between body composition, sarcopenia, arteriosclerosis, and osteoporosis are not fully understood. AI-based CT analysis provides a more holistic picture of multimorbidity in COPD.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Intermuscular adipose tissue (IMAT) was independently associated with vascular calcification in stepwise-adjusted models. The interaction of IMAT and bone density is demonstrated but showed age-dependence.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Increased IMAT can capture a vulnerable COPD patient group with metabolic dysregulation and physical frailty, besides vascular aging. Muscle fat infiltration may indicate impaired musculoskeletal health and serve as a marker of arteriosclerosis beyond possible effects of age or BMI.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12677-3","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T16:42:14Z","timestamp":1783096934000},"page":"7928-7939","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Body composition\u2019s effect on the bone\u2013vascular axis of osteoporosis discovered in AI-based CT analysis of COPD patients"],"prefix":"10.1007","volume":"36","author":[{"given":"Bettina K.","family":"Budai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ondrej","family":"Havlicek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Konietzke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franziska C.","family":"Trudzinski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Biederer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus P.","family":"Heu\u00dfel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Ulrich","family":"Kauczor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4369-6752","authenticated-orcid":false,"given":"Viktoria","family":"Palm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"On behalf of the COSYCONET study group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"12677_CR1","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.05.020415","volume":"5","author":"D Adeloye","year":"2015","unstructured":"Adeloye D, Chua S, Lee C et al (2015) Global and regional estimates of COPD prevalence: systematic review and meta-analysis. 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F.C.T. reports receiving honoraria for lectures and presentations from Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Grifols, Novartis, CSL Behring, Streamed Up, and RG Gesellschaft f\u00fcr Information und Organisation mbH, as well as research funding from the E&H Knorr Stiftung. C.P.H. reports stock ownership in GSK, receiving consultation fees from Voiant from 2025, research funding from Exscientia between 2023 and 2024, and honoraria for lectures from AstraZeneca, Pfizer, Chiesi, and Sanofi, as well as being a patent holder of Method and Device for Representing the Microstructure of the Lungs, IPC8 Class: AA61B5055FI, PAN: 20080208038. C.P.H. is a member of the\n                      European Radiology\n                      Editorial Board and, as such, has not participated in the review or selection processes for this article. H.U.K. reports receiving honoraria for lectures and presentations from Boehringer Ingelheim, Siemens, Philips, and Streamed Up, as well as research funding from Boehringer Ingelheim, Siemens, Philips, as well as serving on advisory boards for Contextflow and Median. H.U.K. is a member of the\n                      European Radiology\n                      Editorial Board and, as such, has not participated in the review or selection processes for this article. J.B. is a member of the\n                      European Radiology\n                      Editorial Board and, as such, has not participated in the review or selection processes for this article. The remaining authors declare no conflicts of interest.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"One of the authors has significant statistical expertise.","order":3,"name":"Ethics","label":"Statistics and biometry","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Written informed consent was obtained from all subjects (patients) in this study.","order":4,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Institutional Review Board approval was obtained. The COSYCONET study was approved by the Ethical Committee of Philipps University Marburg (reference no. AZ 2010-28), as well as the ethics committees of each center.","order":5,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"No study subjects or cohorts have previously been reported.","order":6,"name":"Ethics","label":"Study subjects or cohorts overlap","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"order":7,"name":"Ethics","label":"Methodology","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}}]}}