Evidence map›Paper›PMID 32474604›Full record

Observational studyThe Journal of clinical endocrinology and metabolism2020

Biomarkers of Bone Turnover Identify Subsets of Chronic Kidney Disease Patients at Higher Risk for Fracture.

Jan M Hughes-Austin, Ronit Katz, Richard D Semba, Stephen B Kritchevsky, Douglas C Bauer, Mark J Sarnak, Charles Ginsberg, Michael G Shlipak, Florence Lima, Hartmut H Malluche and 1 more

Open access · bronzeAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in The Journal of clinical endocrinology and metabolism, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 1 pooled it
2.0field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Bone turnover markers in the management of CKD-associated osteoporosis-a European consensus.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2026
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 7 institutions in 1 country.

Jan M Hughes-AustinDepartment of Orthopaedic Surgery, School of Medicine, University of California, San Diego, La Jolla, California.
Ronit KatzDivision of Nephrology, Department of Medicine, University of Washington, Seattle, Washington.
Richard D SembaDepartment of Ophthalmology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
Stephen B KritchevskyDepartment of Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
Douglas C BauerDivision of General Internal Medicine, School of Medicine, University of California, San Francisco, San Francisco, California.
Mark J SarnakDivision of Nephrology, School of Medicine,Tufts University, Boston, Massachusetts.
Charles GinsbergDivision of Nephrology-Hypertension, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California.
Michael G ShlipakDivision of General Internal Medicine, School of Medicine, University of California, San Francisco, San Francisco, California.
Florence LimaDivision of Nephrology, Bone and Mineral Metabolism, Department of Medicine, University of Kentucky, Lexington, Kentucky.
Hartmut H MallucheDivision of Nephrology, Bone and Mineral Metabolism, Department of Medicine, University of Kentucky, Lexington, Kentucky.
Joachim H IxDivision of Nephrology-Hypertension, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California.
University of California San Diego · USUniversity of California, San Francisco · USUniversity of Kentucky · USJohns Hopkins University · USTufts University · USUniversity of Washington · USWake Forest University · US

Funding

The Aging Kidney: Chronic Injury, Impaired Functions and Clinical OutcomesR01AG027002 · NIA · TUFTS MEDICAL CENTER · PI PARIKH, SAMIR M, SARNAK, MARK J · 2005 to 2022
$7.3M
Renal Osteodystrophy: A Fresh ApproachR01DK080770 · NIDDK · UNIVERSITY OF KENTUCKY · PI MALLUCHE, HARTMUT H · 2009 to 2019
$4.8M
Hip Fracture Pathology in Chronic Kidney DiseaseR01AG065876 · NIA · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Jan Marie Hughes-Austin · 2020 to 2026
$3.8M
Peripheral Nerve Function Decline in an Aged CohortR01AG028050 · NIA · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI STROTMEYER, ELSA S. · 2007 to 2015
$3.5M
End of Life in the Very OldR01NR012459 · NINR · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI ALBERT, STEVEN M, LUNNEY, JUNE R · 2011 to 2015
$2.7M
DYNAMICS OF HEALTH .AGING . AND BODY COMPOSITION /Pittsburgh/-260962101N01AG062101 · NIA · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 1996 to 2004
$996k
Antibodies to Citrullinated Protein Antigens, CVD and Bone Disease in MESAK01HL122394 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI HUGHES-AUSTIN, JAN MARIE · 2015 to 2019
$836k
DYNAMICS OF HEALTH . AGING . AND BODY COMPOSITION /Memphis/-26062103N01AG062103 · NIA · UNIVERSITY OF TENNESSEE HEALTH SCI CTR · 1996 to 2004
$793k
Mentored Patient Oriented Research in Kidney DiseaseK24DK110427 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI IX, JOACHIM H · 2016 to 2020
$780k
The Effect of Human Leukocyte Antigen Type on Associations between Antibodies to Citrullinated Protein Antigens (ACPA) and Myocardial Structure and FunctionR03HL146875 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI HUGHES-AUSTIN, JAN MARIE · 2019 to 2020
$157k
HEALTH ABC--COORDINATING UNIT /California/-260062106N01AG062106 · NIA · UNIVERSITY OF CALIFORNIA SAN FRANCISCO · 1996 to 2004
$109k
NHLBI NIH HHS K01 HL122394NHLBI NIH HHS R03 HL146875NIA NIH HHS N01 AG062101NIA NIH HHS N01 AG062103NIA NIH HHS N01 AG062106NIA NIH HHS R01 AG027002NIA NIH HHS R01 AG028050NIA NIH HHS R01 AG065876NIDDK NIH HHS K24 DK110427NIDDK NIH HHS R01 DK080770NINR NIH HHS R01 NR012459
6 · The paper itself

Abstract

backgroundWe sought to identify biomarkers that indicate low turnover on bone histomorphometry in chronic kidney disease (CKD) patients, and subsequently determined whether this panel identified differential risk for fractures in community-dwelling older adults.

methodsAmong CKD patients who underwent iliac crest bone biopsies and histomorphometry, we evaluated candidate biomarkers to differentiate low turnover from other bone disease. We applied this biomarker panel to 641 participants in the Health Aging and Body Composition Study (Health ABC) study with estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 who were followed for fracture. Cox proportional hazards models evaluated the association of bone mineral density (BMD) with fracture risk and determined whether biomarker-defined low bone turnover modified fracture risk at any level of BMD.

resultsIn 39 CKD patients age 64 ± 13 years, 85% female, with mean eGFR 37 ± 14 mL/min/1.73 m2 who underwent bone biopsy, lower fibroblast growth factor (FGF)-23, higher ɑ-Klotho, and lower parathyroid hormone (PTH) indicated low bone turnover in accordance with bone histomorphometry parameters (individual area under the curve = 0.62, 0.73, and 0.55 respectively; sensitivity = 22%, specificity = 100%). In Health ABC, 641 participants with CKD were age 75 ± 3 years , 49% female, with mean eGFR 48 ± 10 mL/min/1.73 m2. For every SD lower hip BMD at baseline, there was an 8-fold higher fracture risk in individuals with biomarker-defined low turnover (hazard ratio 8.10 [95% CI, 3.40-19.30]) vs a 2-fold higher risk in the remaining individuals (hazard ratio 2.28 [95% CI, 1.69-3.08]) (Pinteraction = .082).

conclusionsIn CKD patients who underwent bone biopsy, lower FGF-23, higher ɑ-Klotho, and lower PTH together had high specificity for identifying low bone turnover. When applied to older individuals with CKD, BMD was more strongly associated with fracture risk in those with biomarker-defined low turnover.

Indexed as

AgedAge FactorsBiomarkersBiopsyBone DensityBone RemodelingFemaleFibroblast Growth Factor-23Fibroblast Growth FactorsFractures, BoneGlucuronidaseHumansIliumKlotho ProteinsMaleMiddle AgedBiomarkersFGF23 protein, humanFibroblast Growth Factor-23Fibroblast Growth FactorsGlucuronidaseKlotho ProteinsParathyroid Hormonebone mineral densitybone turnoverchronic kidney diseasefibroblast growth factor (FGF)-23fractureparathyroid hormoneα-Klotho

Identifiers

PMID32474604
PMCPMC7340189
OpenAlexW3031401804

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.