Fibroblast Growth Factor-23 as a biomarker to refine cardiovascular risk identification: A cross-sectional study in postmenopausal osteoporosis

Postmenopausal osteoporosis presents with heterogeneous comorbidities including cardiovascular disease. Objectives of this study were the identification of clusters of osteoporotic patients in relation to the cardiovascular risk, comorbidities, and levels of intact Fibroblast Growth Factor (iFGF23), a key player of the bone-cardiovascular axis.

This cross-sectional study in postmenopausal women with osteoporosis took place in the Rheumatology Department, University Hospital Clermont-Ferrand, France. Twelve variables representative of comorbidities were selected according to their associations and clinical relevance: age, bone mineral density, flow-mediated dilation, cardiovascular risk (SCORE2/2OP), muscle mass, handgrip, sleep, quality of life, pain and plasma iFGF23. Multiple correspondence analysis followed by hierarchical clustering was used to propose profiles of patients and associations related to iFGF23 and cardiovascular risk.

Three comorbidity clusters were identified in 102 women (69.1 ± 7.7 years old): clusters of older age with worse outcomes, of younger age with better results and an intermediate cluster. iFGF23 is unveiled as a marker of the cardiovascular risk even in patients with normal renal function, with a threshold of 94.14 ng/L, and is significantly associated with age, fat mass, poor handgrip, poor quality of life, pain and impaired sleep.

Comorbidity clusters of post-menopausal osteoporosis based on the severity of health impairment highlight in this exploratory study iFGF23 as a possible biomarker of the cardiovascular risk. We suggest that iFGF23 measurement may complement SCORE2/2OP calculation to better predict the cardiovascular risk of osteoporosis patients. A suggested hypothesis-generating algorithm is proposed and future validation in a larger prospective study is warranted.