Department of Internal Medicine, Military Hospital, Tunis, Tunisia; University of Tunis El Manar - Tunisia.
Department of Internal Medicine, Military Hospital, Tunis, Tunisia; University of Tunis El Manar - Tunisia.
J Clin Densitom. 2021 Jan-Mar;24(1):22-27. doi: 10.1016/j.jocd.2020.11.002. Epub 2020 Nov 20.
Mechanisms underlying bone fragility in patients under dialysis are various. The assessment of bone disorder is not yet codified in these patients. Our study aimed to determine the relationship between the serum fibroblast growth factor 23 (FGF23) level and bone fragility. We also aimed to assess the bone alkaline phosphatase (bAP) to the C-terminal telopeptide of type I (CTX) ratio and the FGF23*bAP product to CTX ratio in patients under hemodialysis.
We conducted a cross-sectional study, including 76 patients under hemodialysis. To assess bone fragility, we measured bAP, CTX, and FGF 23. We calculated the bAP to the CTX ratio (bAP/CTX) and the FGF23bAP product to the CTX ratio (FGF23bAP/CTX). We defined bone fragility as the existence of osteoporosis or fragility fractures. Receiver operating characteristic (ROC) curves were evaluated for each biological using the existence of osteoporosis or fragility fracture as the gold standard for bone fragility.
There were 51 men. The mean age was 53.36 ± 14.27 years. Bone fragility was noted in 25 cases. Patients with osteoporosis had higher FGFbAP/CTX and bAP/CTX ratios. The ability of the ratio (bAP/CTX) to distinguish patients with osteoporosis from those without osteoporosis was good, with a ROC AUC of 0.707. The optimal ratio cut-off value with the highest accuracy was 9.72. The ability of the ratio (FGF23bAP/CTX) to distinguish patients with bone fragility was good, with a ROC AUC of 0.701. The optimal ratio cut-off value with the highest accuracy was 1621.89 (sensitivity 60%, specificity 78.4%).
Our study showed FGF23, FGF23*bAP product to CTX ratio, and the bAP to CTX ratio can be used as markers of bone fragility in hemodialysis patients. Therefore, these noninvasive and relatively inexpensive methods may serve to diagnose bone fragility in patients under hemodialysis.
在透析患者中，导致骨脆弱的机制多种多样。目前，这些患者的骨疾病评估尚未规范化。我们的研究旨在确定血清成纤维细胞生长因子 23（FGF23）水平与骨脆弱之间的关系。我们还旨在评估血液透析患者的骨碱性磷酸酶（bAP）与 I 型胶原 C 端肽（CTX）的比值以及 FGF23*bAP 产物与 CTX 的比值。
我们进行了一项横断面研究，纳入了 76 名血液透析患者。为了评估骨脆弱，我们测量了 bAP、CTX 和 FGF23。我们计算了 bAP 与 CTX 的比值（bAP/CTX）和 FGF23bAP 产物与 CTX 的比值（FGF23bAP/CTX）。我们将骨脆弱定义为骨质疏松症或脆性骨折的存在。使用骨质疏松症或脆性骨折的存在作为骨脆弱的金标准，评估每个生物标志物的接收者操作特征（ROC）曲线。
共有 51 名男性，平均年龄为 53.36±14.27 岁。25 例患者存在骨质疏松症。患有骨质疏松症的患者的 FGFbAP/CTX 和 bAP/CTX 比值更高。比值（bAP/CTX）区分骨质疏松症患者和非骨质疏松症患者的能力较好，ROC 曲线下面积为 0.707。最佳比值截断值具有最高准确性为 9.72。比值（FGF23bAP/CTX）区分骨脆弱患者的能力较好，ROC 曲线下面积为 0.701。最佳比值截断值具有最高准确性为 1621.89（敏感性 60%，特异性 78.4%）。
我们的研究表明，FGF23、FGF23*bAP 产物与 CTX 的比值以及 bAP/CTX 比值可作为血液透析患者骨脆弱的标志物。因此，这些非侵入性和相对便宜的方法可用于诊断血液透析患者的骨脆弱。
