FGF23 levels as a marker of physical performance and falls in community-dwelling very old individuals

Mariana Zuccolotto Foroni; Maysa Seabra Cendoroglo; Aline Granja Costa; Rosangela Villa Marin-Mio; Patricia Ferreira do Prado Moreira; Sergio Setsuo Maeda; John P Bilezikian; Marise Lazaretti-Castro

doi:10.20945/2359-3997000000488

FGF23 levels as a marker of physical performance and falls in community-dwelling very old individuals

Arch Endocrinol Metab. 2022 May 25;66(3):333-344. doi: 10.20945/2359-3997000000488. Epub 2022 May 25.

Authors

Mariana Zuccolotto Foroni¹, Maysa Seabra Cendoroglo², Aline Granja Costa³, Rosangela Villa Marin-Mio³, Patricia Ferreira do Prado Moreira², Sergio Setsuo Maeda³, John P Bilezikian⁴, Marise Lazaretti-Castro³

Affiliations

¹ Divisão de Endocrinologia, Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil, marianazforoni@gmail.com.
² Divisão de Geriatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil.
³ Divisão de Endocrinologia, Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil.
⁴ Department of Medicine, Division of Endocrinology, College of Physicians and Surgeons, Columbia University, New York, New York, USA.

Abstract

Objective: The fibroblast growth factor 23 (FGF23) has been related to biological aging, but data in elderly individuals are scant. We determined the profile of serum FGF23 levels in a population of very-old individuals and studied their correlations with parameters of bone metabolism and health markers, as functional performance.

Methods: This cross-sectional study was performed on 182 community dwellers aged ≥ 80 years. Serum levels of FGF23, PTH, calcium, albumin, phosphorus, creatinine, bone markers, and bone mineral density data were analyzed. Physical performance was evaluated with the stationary march (Step), Flamingo, and functional reach tests, along with questionnaires to assess falls and fractures in the previous year, energy expenditure (MET), and the Charlson index (CI). Physical activity was evaluated with the International Physical Activity Questionnaire (IPAQ).

Results: Most participants (75%) had FGF23 levels between 30-120 RU/mL (range: 6.0-3,170.0 RU/mL). FGF23 levels correlated with estimated glomerular filtration rate (eGFR; r = -0.335; p = 0.001) and PTH (r = 0.318; p < 0.0001). Individuals with FGF23 in the highest tertile had more falls in the previous year (p = 0.032), worse performance in the Flamingo (p = 0.009) and Step (p < 0.001) tests, worse CI (p = 0.009) and a trend toward sedentary lifestyle (p = 0.056). On multiple regression, FGF23 tertiles remained significant, independently of eGFR, for falls in the previous year, performance in the Flamingo and stationary march tests, lean mass index, and IPAQ classification.

Conclusion: In a population of very elderly individuals, FGF23 levels were inversely associated with neuromuscular and functional performances. Higher concentrations were related to more falls, lower muscle strength and aerobic capacity, and poorer balance, regardless of renal function, suggesting a potentially deleterious role of high FGF23 concentrations in musculoskeletal health.

Keywords: Fibroblast growth factor 23; aging; body balance; falls; muscle strength; physical performance; very old.

MeSH terms

Accidental Falls*
Aged, 80 and over
Biomarkers* / blood
Bone Density / physiology
Cross-Sectional Studies
Exercise / physiology
Female
Fibroblast Growth Factor-23* / blood
Fibroblast Growth Factors / blood
Glomerular Filtration Rate / physiology
Humans
Independent Living
Male
Physical Functional Performance

Substances

Biomarkers
FGF23 protein, human
Fibroblast Growth Factor-23
Fibroblast Growth Factors

Grants and funding

this study was funded by the Foundation for Research Support of the State of São Paulo – Fapesp (2011/12753-8). We thank Capes (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) for the support of our Brazilian post-graduation research program.