The International Journal of Romanian Society of Endocrinology / Registered in 1938

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January - March 2021, Volume 17, Issue 1
Endocrine Care

Nita G, Nita O, Gherasim A, Arhire LI, Herghelegiu AM, Mihalache L, Tuchilus C, Graur M

The Role of RANKL and FGF23 in Assessing Bone Turnover in Type 2 Diabetic Patients

Acta Endo (Buc) 2021, 17 (1): 51-59
doi: 10.4183/aeb.2021.51

Context. Type 2 diabetes is a chronic metabolic disease which affects bone. There is evidence in the literature about some serum markers that reflect the bone turnover metabolism, such as RANKL (Receptor Activator of Nuclear factor Kappa-b Ligand) and Fibroblast Growth Factor (FGF) 23. Objective. We aimed to investigate the correlations between RANKL and FGF23 and other diabetes-related factors possibly influencing early bone turnover changes. Subjects and Method. We conducted a crosssectional analytical study on a group of 171 patients with type 2 diabetes, without Charcot’s arthropathy or a history of amputations, in which a complete history and anthropometric, clinical, biochemical and dietary evaluation were performed. We evaluated the serum level of RANKL and FGF 23. Results. RANKL was significantly lower in patients with macroangiopathy (0.42±0.15 pmol/L vs. 0.47±0.2 pmol/L, p=0.001). The level of FGF23 was lower in patients with neuropathy (0.37±0.36 pmol/L vs. 0.41±0.17 pmol/L, p=0.001). We found that FGF23 increased with age, but decreased with the duration of diabetes. We also found an inverse relationship between FGF23 levels and HbA1c, triglycerides, diastolic blood pressure, total proteins, albuminemia. Conclusions. RANKL was significantly lower in patients with macroangiopathy, and FGF 23 in patients with neuropathy. Therefore, more studies are needed to elucidate their role in early bone turnover changes.

Keywords: RANKL, FGF23, bone turnover, type 2 diabetes.

Correspondence: Andreea Gherasim MD, “Grigore T. Popa” University of Medicine and Pharmacy, Diabetes, Nutrition and Metabolic Diseases, Bld Independentei nr 1, Iasi, 700111, Romania, E-mail: