ArticleThe Journal of clinical endocrinology and metabolism2022
FGF23-Klotho Axis and Fractures in Patients Without and With Early CKD: A Case-Cohort Analysis of CARTaGENE.
Article in The Journal of clinical endocrinology and metabolism, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Association of aberrant mineral metabolic markers with fracture risk in chronic kidney disease: a comprehensive meta-analysis.BMC nephrology · 2025Pooled it
- Advances in noninvasive diagnosis of renal osteodystrophy.Renal failure · 2025Review
- The Conundrum of Medical Fracture Prevention in Chronic Kidney Disease-Summary of the Evidence and Pragmatic Clinical Guidance.Journal of clinical medicine · 2025Review
- [Potential of early diagnosis and targeted therapy for Klotho protein in chronic kidney disease].Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences · 2025Review
- Serum alpha-klotho levels associate with bone mineral density in chronic kidney disease patients from NHANES 2011 to 2016.Scientific reports · 2025Article
- Association between serum α-Klotho levels and mortality in US adults with osteoporosis.BMC public health · 2025Article
- Evaluation of complications in patients with mandible fractures undergoing chronic kidney disease in the United States.BMC oral health · 2024Article
- Non-Classical Effects of FGF23: Molecular and Clinical Features.International journal of molecular sciences · 2024Review
- Soluble Klotho, a Potential Biomarker of Chronic Kidney Disease-Mineral Bone Disorders Involved in Healthy Ageing: Lights and Shadows.International journal of molecular sciences · 2024Review
- Relationship between bone marrow adipose tissue and kidney function in postmenopausal women.Bone reports · 2023Article
- U-shaped association between serum Klotho and accelerated aging among the middle-aged and elderly US population: a cross-sectional study.BMC geriatrics · 2023Article
- Added value of waist circumference to body mass index for predicting fracture risk in obesity: a prospective study from the CARTaGENE cohort.Archives of osteoporosis · 2023Article
- Wnt/β-catenin pathway inhibitors, bone metabolism and vascular health in kidney transplant patients.Journal of nephrology · 2023Observational
- Relationships between Obesity and Incidence of Fractures in a Middle-Aged Population: A Study from the CARTaGENE Cohort.JBMR plus · 2023Article
- Article
- Association between soluble α-klotho and mortality risk in middle-aged and older adults.Frontiers in endocrinology · 2023Article
- FGF23-Klotho Axis and Fractures in Patients Without and With Early CKD: A Case-Cohort Analysis of CARTaGENE.The Journal of clinical endocrinology and metabolism · 2022Article
- Bone Marrow Adiposity, Bone Mineral Density and Wnt/β-catenin Pathway Inhibitors Levels in Hemodialysis Patients.Journal of bone metabolism · 2022Article
- The controversy of klotho as a potential biomarker in chronic kidney disease.Frontiers in pharmacology · 2022Review
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
contextWhether fibroblast growth factor-23 (FGF23) and α-Klotho are associated with fractures, especially in chronic kidney disease (CKD), remains controversial.
objectiveWe evaluated how FGF23, α-Klotho, and traditional mineral parameters predict fractures in individuals with and without early CKD.
methodsWe conducted a stratified case-cohort analysis using CARTaGENE, a population-based survey from Quebec, Canada. Individuals aged 40 to 69 years were selected according to outcome and CKD status (non-CKD: eGFR > 60 mL/min/1.73 m2; CKD stage 3: eGFR 30-60 mL/min/1.73 m2]). Baseline levels of c-terminal FGF23 (cFGF23), α-Klotho, parathyroid hormone (PTH), phosphate, and calcium were analyzed for associations with osteoporotic fracture incidence from recruitment (2009-2010) through March 2016. Adjusted Cox models were used, and predictors were treated linearly or flexibly using splines.
resultsA total of 312 patients (159 non-CKD; 153 CKD) were included; 98 had ≥ 1 fracture at any site during a median follow up of 70 months. Compared with non-CKD, CKD patients had increased levels of cFGF23 but similar levels of α-Klotho. cFGF23 was linearly associated with increased fracture incidence (adjusted HR = 1.81 [1.71, 1.93] per doubling for all participants). The association of α-Klotho with fracture followed a U-curve (overall P = 0.019) but was attenuated by adjustment for potential mediators (bone mineral density, phosphate, PTH). PTH and phosphate also had U-shaped associations with fracture. Associations were mostly similar between non-CKD and CKD. Adjustment for cFGF23 strongly attenuated the association between CKD status and fractures.
conclusioncFGF23 is associated linearly with fracture incidence while α-Klotho, PTH, and phosphate levels have a U-shaped association.
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