Biomarkers of Bone Turnover Identify Subsets of Chronic Kidney Disease Patients at Higher Risk for Fracture.

Abstract

BACKGROUND:

We sought to identify biomarkers that indicate low turnover on bone histomorphometry in chronic kidney disease (CKD) patients, and subsequently determined whether this panel identified differential risk for fractures in community-dwelling older adults.

METHODS:

Among CKD patients who underwent iliac crest bone biopsies and histomorphometry, we evaluated candidate biomarkers to differentiate low turnover from other bone disease. We applied this biomarker panel to 641 participants in the Health Aging and Body Composition Study (Health ABC) study with estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 who were followed for fracture. Cox proportional hazards models evaluated the association of bone mineral density (BMD) with fracture risk and determined whether biomarker-defined low bone turnover modified fracture risk at any level of BMD.

RESULTS:

In 39 CKD patients age 64 ± 13 years, 85% female, with mean eGFR 37 ± 14 mL/min/1.73 m2 who underwent bone biopsy, lower fibroblast growth factor (FGF)-23, higher ɑ-Klotho, and lower parathyroid hormone (PTH) indicated low bone turnover in accordance with bone histomorphometry parameters (individual area under the curve = 0.62, 0.73, and 0.55 respectively; sensitivity = 22%, specificity = 100%). In Health ABC, 641 participants with CKD were age 75 ± 3 years , 49% female, with mean eGFR 48 ± 10 mL/min/1.73 m2. For every SD lower hip BMD at baseline, there was an 8-fold higher fracture risk in individuals with biomarker-defined low turnover (hazard ratio 8.10 [95% CI, 3.40-19.30]) vs a 2-fold higher risk in the remaining individuals (hazard ratio 2.28 [95% CI, 1.69-3.08]) (Pinteraction = .082).

CONCLUSIONS:

In CKD patients who underwent bone biopsy, lower FGF-23, higher ɑ-Klotho, and lower PTH together had high specificity for identifying low bone turnover. When applied to older individuals with CKD, BMD was more strongly associated with fracture risk in those with biomarker-defined low turnover.

• Authors: Jan M Hughes-Austin, Ronit Katz, Richard D Semba, Stephen B Kritchevsky, Douglas C Bauer, Mark J Sarnak, Charles Ginsberg, Michael G Shlipak, Florence Lima, Hartmut H Malluche, Joachim H Ix
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 105 Issue 8 (08 01 2020) ISSN: 1945-7197 [Electronic] United States
• PMID: 32474604 (Publication Type: Journal Article, Observational Study, Research Support, N.I.H., Extramural, Research Support, N.I.H., Intramural, Research Support, Non-U.S. Gov't)
• Copyright: © Endocrine Society 2020. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Biomarkers
• FGF23 protein, human
• Parathyroid Hormone
• Fibroblast Growth Factors
• Fibroblast Growth Factor-23
• Glucuronidase
• Klotho Proteins

Topics

• Age Factors
• Aged
• Biomarkers (analysis, metabolism)
• Biopsy
• Bone Density (physiology)
• Bone Remodeling (physiology)
• Female
• Fibroblast Growth Factor-23
• Fibroblast Growth Factors (analysis, metabolism)
• Fractures, Bone (epidemiology, etiology, physiopathology)
• Glucuronidase (analysis, metabolism)
• Humans
• Ilium (pathology)
• Klotho Proteins
• Male
• Middle Aged
• Parathyroid Hormone (analysis, metabolism)
• Prospective Studies
• Renal Insufficiency, Chronic (complications, physiopathology)
• Risk Assessment (methods)
• Risk Factors