Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jan 15, 2025; 16(1): 98714
Published online Jan 15, 2025. doi: 10.4239/wjd.v16.i1.98714
Risk factors for developing osteoporosis in diabetic kidney disease and its correlation with calcium-phosphorus metabolism, FGF23, and Klotho
Fan Yang, Yan Wu, Wei Zhang
Fan Yang, Wei Zhang, Department of Endocrinology, Wuhu Second People's Hospital, Wuhu 241000, Anhui Province, China
Yan Wu, Department of Nephrology, Wuhu Second People's Hospital, Wuhu 241000, Anhui Province, China
Co-first authors: Fan Yang and Yan Wu.
Author contributions: Yang F and Wu Y conceived and designed the experiments; Yang F and Wu Y analyzed the data; Yang F and Wu Y contributed to the data curation; Yang F and Wu Y wrote-original draft preparation; Yang F, Wu Y and Zhang W participated in the writing-review and editing. Yang F and Wu Y contributed equally to this work as co-first authors.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Wuhu Second People's Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Zhang, PhD, Doctor, Department of Endocrinology, Wuhu Second People's Hospital, No. 259 Jiuhua Middle Road, Jinghu District, Wuhu 241000, Anhui Province, China. traveller304@sina.com
Received: July 24, 2024
Revised: September 15, 2024
Accepted: November 5, 2024
Published online: January 15, 2025
Processing time: 128 Days and 15.8 Hours
Abstract
BACKGROUND

The progression of diabetic kidney disease (DKD) affects the patient’s kidney glomeruli and tubules, whose normal functioning is essential for maintaining normal calcium (Ca) and phosphorus (P) metabolism in the body. The risk of developing osteoporosis (OP) in patients with DKD increases with the aggravation of the disease, including a higher risk of fractures, which not only affects the quality of life of patients but also increases the risk of death.

AIM

To analyze the risk factors for the development of OP in patients with DKD and their correlation with Ca-P metabolic indices, fibroblast growth factor 23 (FGF23), and Klotho.

METHODS

One hundred and fifty-eight patients with DKD who were admitted into the Wuhu Second People’s Hospital from September 2019 to May 2021 were selected and divided into an OP group (n = 103) and a normal bone mass group (n = 55) according to their X-ray bone densitometry results. Baseline data and differences in Ca-P biochemical indices, FGF23, and Klotho were compared. The correlation of Ca-P metabolic indices with FGF23 and Klotho was discussed, and the related factors affecting OP in patients with DKD were examined by multivariate logistic regression analysis.

RESULTS

The OP group had a higher proportion of females, an older age, and a longer diabetes mellitus duration than the normal group (all P < 0.05). Patients in the OP group exhibited significantly higher levels of intact parathyroid hormone (iPTH), blood P, Ca-P product (Ca × P), fractional excretion of phosphate (FeP), and FGF23, as well as lower estimated glomerular filtration rate, blood Ca, 24-hour urinary phosphate excretion (24-hour UPE), and Klotho levels (all P < 0.05). In the OP group, 25-(OH)-D3, blood Ca, and 24-hour UPE were negatively correlated with FGF23 and positively correlated with Klotho. In contrast, iPTH, blood Ca, Ca × P, and FeP exhibited a positive correlation with FGF23 and an inverse association with Klotho (all P < 0.05). Moreover, 25-(OH)-D3, iPTH, blood Ca, FePO4, FGF23, Klotho, age, and female gender were key factors that affected the lumbar and left femoral neck bone mineral density.

CONCLUSION

The Ca-P metabolism metabolic indexes, FGF23, and Klotho in patients with DKD are closely related to the occurrence and development of OP.

Keywords: Diabetic kidney disease; Osteoporosis; Calcium-phosphorus metabolism; FGF23; Klotho

Core Tip: The risk of developing osteoporosis (OP) in patients with diabetic kidney disease (DKD) increases with the worsening of DKD. In addition, the risk of fractures in DKD is greatly increased, which affects the patient’s quality of life and elevates the risk of death. Therefore, it is of great importance to identify the risk factors that affect the occurrence of OP in patients with DKD to guide appropriate interventions. In this study, we analyzed the risk factors of OP in patients with DKD to enable planning appropriate fracture prevention strategies.