Abstract: FR-PO250
Bone Phenotype and Fracture Risk in Patients with Type 2 Diabetes at the Time of Kidney Transplantation
Session Information
- Mineral Bone Disease: Transplant and Kidney Stones
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Hauge, Sabina Chaudhary, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Joergensen, Hanne Skou, Aalborg University Hospital, Aalborg, Denmark
- Claes, Kathleen, Katholieke Universiteit Leuven, Leuven, Belgium
- D'Haese, Patrick, University of Antwerp, Antwerpen, Belgium
- Verhulst, Anja, University of Antwerp, Antwerpen, Belgium
- Cavalier, Etienne, University of Liege, Liege, Belgium
- Hansen, Ditte, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Evenepoel, Pieter, Katholieke Universiteit Leuven, Leuven, Belgium
Background
Type 2 diabetes mellitus (T2DM) associates with an increased fracture risk in patients with and without chronic kidney disease (CKD), but underlying mechanisms remain poorly understood. This study investigates the mineral and bone phenotype as well as the fracture risk in patients with T2DM and CKD grade 5-5D (CKDG5-5D).
Methods
Parameters of mineral metabolism (fibroblast growth factor 23 (FGF23), sclerostin) and bone turnover (bone alkaline phosphatase (BALP), pro-collagen type I N-terminal propeptide (intact PINP), tartrate-resistant acid phosphatase 5b (TRAP5b)), bone mineral density (BMD, n=555), and trabecular bone score (TBS, n=198) were assessed in 647 patients (T2DM, n=102) at time of kidney transplantation. Bone histomorphometry was available for 188 patients. Patients with type 1 diabetes were excluded. Fragility fractures were retrieved from medical records.
Results
T2DM associated with higher Z-scores at the lumbar spine (-0.066 vs. -0.760, p<0.001) and femoral neck (-0.679 vs. -0.961, p=0.041), but lower TBS (1.223 vs. 1.294, p=0.010). Intact PINP (68.4 vs. 82.0 ng/mL, p=0.033) and FGF23 (1516 vs. 2449 pg/mL, p=0.027) were lower, while sclerostin (2.1 vs. 1.8 ng/mL, p=0.042) was higher in T2DM vs non-T2DM. Bone histomorphometry revealed no differences in bone microarchitecture, turnover or mineralization. During a median follow-up of 10 years 17% with T2DM and 13% non-T2DM sustained a fragility fracture (p=0.343). In cox regression analysis T2DM did not associate with increased fracture risk of fragility fracture (HR: 1.25; CI 0.71-2.18, p=0.437) after adjusting for age, sex, and BMI.
Conclusion
T2DM associated with a distinct bone phenotype characterized by suppressed bone turnover, higher BMD at trabecular sites, and higher circulating sclerostin levels, but T2DM did not associate with an increased fracture risk.
Funding
- Private Foundation Support