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High FGF23 levels are associated with impaired trabecular bone microarchitecture in patients with osteoporosis

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Abstract

Summary

This cross-sectional study examined the associations between c-terminal FGF23 levels, laboratory markers of bone metabolism and bone microarchitecture in 82 patients with osteoporosis. Higher FGF23 levels were associated with impaired trabecular but not cortical bone microarchitecture, and this was confirmed after adjusting for confounding variables such as age or BMI.

Introduction

Fibroblast growth factor 23 (FGF23) is an endocrine hormone-regulating phosphate and vitamin D metabolism. While its mode of action is well understood in diseases such as hereditary forms of rickets or tumor-induced osteomalacia, the interpretation of FGF23 levels in patients with osteoporosis with regard to bone microarchitecture is less clear.

Methods

C-terminal FGF23 levels and bone turnover markers were assessed in 82 patients with osteoporosis (i.e., DXA T-score ≤ − 2.5 at the lumbar spine or total hip). Bone microarchitecture was measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) at the distal radius and tibia. Data were analyzed in a cross-sectional design using correlation and regression models.

Results

We found a significant negative logarithmic correlation between FGF23 levels and trabecular but not cortical bone microarchitecture at both skeletal sites. Furthermore, using a multiple linear regression model, we confirmed FGF23 as a predictor for reduced trabecular parameters even when adjusting for confounding factors such as age, BMI, phosphate, bone-specific alkaline phosphatase, vitamin D3, and PTH.

Conclusions

Taken together, high FGF23 levels are associated with impaired trabecular bone microarchitecture in osteoporosis patients, and this association seems to occur after adjustment of confounding variables including phosphate and vitamin D. Future longitudinal studies are now needed to validate our findings and investigate FGF23 in relation to fracture risk.

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Acknowledgments

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany

    T. Rupp, S. Butscheidt, R. Oheim, F. Barvencik, M. Amling & T. Rolvien

  2. Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    S. Butscheidt & T. Rolvien

  3. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    E. Vettorazzi

Authors
  1. T. Rupp
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  2. S. Butscheidt
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  3. E. Vettorazzi
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  4. R. Oheim
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  5. F. Barvencik
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  6. M. Amling
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  7. T. Rolvien
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Contributions

Study design: MA and T Rolvien.

Study conduct: T Rupp, SB, EV, RO, FB, MA, and T Rolvien.

Data analysis: T Rupp, SB, EV, RO, FB, MA, and T Rolvien.

Drafting manuscript: T Rupp and T Rolvien.

Revising manuscript: T Rupp, SB, EV, RO, FB, MA, and T Rolvien. T Rupp and T Rolvien take responsibility for the integrity of the data analysis.

Corresponding author

Correspondence to T. Rolvien.

Ethics declarations

This study was performed in accordance with the Declaration of Helsinki and the rules of the local ethics committee (HmbKHG §12).

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None.

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Rupp, T., Butscheidt, S., Vettorazzi, E. et al. High FGF23 levels are associated with impaired trabecular bone microarchitecture in patients with osteoporosis. Osteoporos Int 30, 1655–1662 (2019). https://doi.org/10.1007/s00198-019-04996-7

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  • DOI: https://doi.org/10.1007/s00198-019-04996-7

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