Fibroblast Growth Factor 23 and Klotho Are Associated With Trabecular Bone Score but Not Bone Mineral Density in the Early Stages of Chronic Kidney Disease: Results of the Cross-Sectional Study

Abstract

This study evaluates bone mineral density (BMD) and trabecular bone score (TBS) in relationship with new markers of chronic kidney disease (CKD), fibroblast growth factor 23 (FGF23), and klotho. The patients in this cross-sectional study were divided as follows: group A -patients in stages G1-3; group B -patients in stages G4 – 5 according to KDIGO. Plasma levels of soluble klotho and FGF23 were determined by ELISA. Bone mineral density (BMD) and trabecular bone score (TBS) were measured. 74 patients with CKD (mean age 68.8 years) were included in the study. Higher levels of FGF23 were observed in group B (N=15) compared to group A (N=59; p=0.001) were observed. FGF23 was higher in group A compared to group B. Significant difference in TBS within the first 3 stages of CKD was observed (mean TBS in G1=1.375 vs. G2=1.340 vs. G3a=1.24; p<0.05) and negative correlation of FGF23 and TBS (R=-0.33; p=0.05) and positive correlation between klotho and TBS (R=0.419; p=0.04) was observed. This study confirmed that FGF23 and klotho are associated with TBS, but TBS reflects a decrease in kidney function only in the first 3 stages of CKD. Thus, FGF23 and klotho together with TBS are promising markers of early trabecular bone impairment in CKD.

Klotho Reduces the Risk of Osteoporosis in Postmenopausal Women: A cross-sectional Study of the National Health and Nutrition Examination Survey (NHANES)

“…Our research has reached a similar conclusion with Kužmová Z et al [25] and Baldan A et al [26] , that is, Klotho is a protein that protects bones. Klotho can reduce the incidence of OP, which means that it can promote the stability of bone trabecular structure and reduce the incidence of osteoporotic fractures.…”

“…The variation of KL is related to the BMD of the population [22][23][24] . Kužmová Z et al [25] found that Klotho was positively correlated with trabecular bone score (TBS) in population with chronic kidney disease (CKD), and negatively correlated with fracture risk. Baldan A et al [26] also found that a decreased Klotho concentration is associate with a higher probability of having had fragility fractures in β-Thalassemia patients.…”

Low Turnover Renal Osteodystrophy With Abnormal Bone Quality and Vascular Calcification in Patients With Mild-to-Moderate CKD

“…The association between Klotho and BMD requires further study. The available data are inconsistent; some studies show no relationship, 50 , 51 , 52 whereas others show a negative correlation. 53 Our findings in these 32 patients with CKD are worth reporting, but they do not allow us to make claims regarding pathogenetic relevance.…”

Soluble Klotho, a Potential Biomarker of Chronic Kidney Disease–Mineral Bone Disorders Involved in Healthy Ageing: Lights and Shadows

“…Recent clinical studies in CKD patients have found that lower levels of serum sKlotho are associated with bone impairment, particularly with altered trabecular microarchitecture [81]. Interestingly, the CARTaGENE health study showed that in CKD, both the lowest and the highest serum sKlotho levels were associated with fractures [82].…”