Effect of Serum Fibroblast Growth Factor-23, Matrix Gla Protein and Fetuin-A in Predicting Osteoporosis in Maintenance Hemodialysis Patients

This study is aimed at exploring the role of serum fibroblast growth factor‐23 (FGF‐23), matrix Gla (MGP) and Fetuin‐A in the calcium‐phosphate metabolism and estimate the value of serum FGF‐23, MGP and Fetuin‐A levels in predicting osteoporosis in maintenance hemodialysis (MHD) patients. This study included 64 patients who receive hemodialysis in our hospital. The serum FGF‐23, MGP and Fetuin‐A were analyzed by enzyme‐linked immunosorbent assay (ELlSA). Bone mineral density (BMD) at the femoral neck was measured by dual‐energy X‐ray absorptiometry. The 64 patients (30 males, 34 females, 60.6 ± 11.3 years of age) received an average of 6.88 ± 2.94 years of dialysis. Body mass index (BMI), Kt/V, dialysis vintage, patient age, serum levels of FGF‐23, Fetuin‐A, bone isoenzyme of alkaline phosphatase (ALP‐B), and calcium were different in statistical significance among the three groups of patients in terms of normal bone mass (N = 10), osteopenia (N = 24), or osteoporosis (N = 30). BMI, Kt/V, ALP‐B, dialysis vintage and serum Fetuin‐A level were identified as independent variables of femoral neck BMD by stepwise multiple regression analysis. The area under ROC curve showed that serum Fetuin‐A was useful for identifying osteoporosis in MHD patients. The cutoff value corresponding to the highest Youden's index was serum Fetuin‐A ≤89 μg/mL, which was defined as the optimal predictor of osteoporosis. Its sensitivity/specificity was 71%/77.8%. The incidence of osteoporosis is high in MHD patients. Serum Fetuin‐A level is closely correlated with osteoporosis and it may serve as a predictor of osteoporosis.