Correlation of fgf23 and balp with bone mineral density in hemodialysis patients

Abstract

Summary Background Chronic kidney disease (CKD) is associated with numerous complications such as bone mineral disorder. The aim of our study was to analyze the correlation of bone turnover markers with Bone Mineral Density (BMD) measurements in Tunisian end stage renal diseases (ESRD) patients. Methods This study included 100 ESRD Tunisian patients. Their estimated glomerular filtration rate (eGFR) was < 15 mL × min-1 × (1.73 m2)-1, which requires hemodialysis. Bone-specific alkaline phosphatase (BALP) serum concentration was determined with a chemiluminescence immunoassay. Fibroblast Growth Factor 23 (FGF23) serum was assessed by Enzyme-Linked Immunosorbent Assay method. The serum levels of 25-Hydroxyvitamin D (25(OH)D), intact parathyroid hormone (iPTH) and Beta cross-laps (CTX) was measured by Electrochemiluminescence Technology. DEXA (dual-energy x-ray absorptiometry) technique was used to evaluate BMD. Results We observed a statistically significant negative correlation between BALP levels and total body BMD (r = -0.268; P = 0.015) particularly in femoral neck (FN) (r = -0.219; P = 0.037). BALP concentrations were negatively associated with total BMD especially in FN for patients with BMI < 30, FGF23 concentrations were also negatively correlated with BMD in lumbar spine site (LS) (r = -0.209; P = 0.046). For osteopenic patients we found an inverse correlation between 25(OH)D concentrations and BMD in LS position (r = -0.336; P = 0.038). In men group, we have also found a negative correlation between iPTH and total BMD (r = -0.326; P = 0.015). However we found a positive correlation between calcium expression and BMD in LS site (r = 0.270; P = 0.031). Conclusions FGF23 and BALP can predict bone loss in ESRD through their strong correlation with BMD in LS and FN sites respectively.

Construction and validation of a predictive model for hypocalcemia after parathyroidectomy in patients with secondary hyperparathyroidism

“…BALP is a glycoprotein synthesized by osteoblasts that hydrolyzes pyrophosphate to produce phosphate during bone mineralization and contributes to hydroxyapatite precipitation. If bone mineralization is disturbed, osteoblasts synthesize more BALP as a negative feedback response ( 30 ), which may explain the high preoperative serum ALP activities identified in patients at high risk of hypocalcemia.…”

The Saga of Endocrine FGFs

“…CKD is an extremely complex disease with complications like renal failure and bone mineral disorder. It has been observed that elevated levels of FGF23 were correlated with bone mineral density in the lumbar spine site in CKD patients [ 154 ]. Thus, FGF23 can be used to predict bone loss at the lumbar spine site in the end stages of CKD [ 154 ].…”

“…It has been observed that elevated levels of FGF23 were correlated with bone mineral density in the lumbar spine site in CKD patients [ 154 ]. Thus, FGF23 can be used to predict bone loss at the lumbar spine site in the end stages of CKD [ 154 ]. On the other hand, a low level of FGF23 is reported in hyperphosphatemic tumoral calcinosis [ 155 ].…”

Fibroblast growth factor 21 (FGF21) is a sensitive marker of osteoporosis in haemodialysis patients: a cross-sectional observational study

“…FGF23 is a 32-kDa glycoprotein secreted by osteocytes and functions in calcium and phosphorus metabolism disorders [11], bone loss [12], vascular calcification [13] and other CKD-MBD events in patients with ESRD. In previous studies, some scholars proposed that FGF23 could predict bone loss in patients with ESRD through its strong correlation with bone mineral density (BMD) in lumbar spine sites and femoral neck sites [14,15]. However, Wohlfahrt P and Isakova T et al drew contradictory conclusions that FGF23 had no correlations with BMD and bone mass corrected for other factors such as height, eGFR and PTH levels [16,17].…”