{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:29:12Z","timestamp":1791613752627,"version":"4.3.4"},"posted":{"date-parts":[[2026,3,5]]},"group-title":"Nephrology","reference-count":18,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"funder":[{"award":["R01 AG065876"],"award-info":[{"award-number":["R01 AG065876"]}],"id":[{"id":"https:\/\/ror.org\/01cwqze88","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,5,27]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:p>Individuals with chronic kidney disease (CKD) have higher rates of hip fracture and post-fracture mortality. Bone pathology in this population can range from low to high bone turnover that standard imaging and blood biomarkers cannot reliably determine. Although novel bone turnover markers have recently been advocated, evidence is limited and focused on iliac crest turnover, not the hip where fractures occur. Therefore, we evaluated whether blood biomarkers of bone turnover correlated with histologically defined turnover at the hip in individuals with CKD and hip fracture.<\/jats:p>\n                <jats:p>\n                  We enrolled 48 adults with CKD and 27 adults without CKD presenting with hip fractures requiring surgery. Blood samples were collected pre-operatively, and bone specimens from the femoral head or greater trochanter were collected during surgery. Plasma biomarkers included \u03b1-Klotho, bone alkaline phosphatase (BAP), dickkopf-related protein 1 (DKK-1), fibroblast growth factor 23 (FGF23), tartrate-resistant acid phosphatase 5b (TRAP5b), parathyroid hormone (PTH), and sclerostin. Bone specimens underwent histomorphometry and osteoblast surface (Ob.S\/BS) and eroded surface (ES\/BS) marked turnover.\n                  <jats:sup>1<\/jats:sup>\n                  Linear regression evaluated associations of the blood biomarkers with Ob.S\/BS and ES\/BS.\n                <\/jats:p>\n                <jats:p>\n                  Among the CKD subset, mean age was 83\u00b110 years, 65% were female, and mean eGFR was 45\u00b115 ml\/min\/1.73m\n                  <jats:sup>2<\/jats:sup>\n                  . Compared to participants without CKD, those with CKD had significantly lower trabecular thickness (Tb.Th) (p=0.021). Within the CKD subset, higher BAP was associated with higher Ob.S\/BS (255% per 2-fold higher; 95% CI: 623\u2013674%) independent of eGFR and other risk factors. Higher TRAP5b was associated with higher Ob.S\/BS (358%; 95% CI: 97-965%) and higher ES\/BS (185%; 95% CI: 38\u2013486%). Higher FGF23 was associated with lower ES\/BS (\u201319%; 95% CI \u2013 31 to \u20134%), while PTH was not associated with either Ob.S\/BS or ES\/BS.\n                <\/jats:p>\n                <jats:p>BAP, TRAP5b, and FGF23 provide blood-based biomarkers that correlate with biopsy confirmed bone turnover at the hip after fractures in patients with CKD.<\/jats:p>\n                <jats:sec>\n                  <jats:title>LAY SUMMARY<\/jats:title>\n                  <jats:p>Individuals with chronic kidney disease have high risk for hip fracture and fracture-related death. This risk is related to bone turnover that can be too high or too low, which common scans and blood tests cannot reliably detect. We studied 48 patients with CKD and 27 without CKD who had hip fractures to determine which blood tests best marked bone turnover seen under the microscope. Several blood markers (BAP, TRAP5b, and FGF23) closely correlated with bone-building and bone breakdown in hip bone samples. These blood tests may guide care after hip fracture in patients with CKD.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.03.04.26347613","type":"posted-content","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T22:35:12Z","timestamp":1772750112000},"source":"Crossref","is-referenced-by-count":1,"title":["Noninvasive Biomarkers of Bone Turnover in Relation to Histomorphometry at the Hip in Patients with Chronic Kidney Disease Undergoing Surgery for Hip Fracture"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7255-274X","authenticated-orcid":false,"given":"Jan M.","family":"Hughes-Austin","sequence":"first","affiliation":[{"name":"University of California, San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Claravall","sequence":"additional","affiliation":[{"name":"University of California, San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronit","family":"Katz","sequence":"additional","affiliation":[{"name":"University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah M.","family":"Kado","sequence":"additional","affiliation":[{"name":"Stanford University, Stanford, California, USA"},{"name":"VA Palo Alto Healthcare System, Palo Alto, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra K.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"University of California, San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William T.","family":"Kent","sequence":"additional","affiliation":[{"name":"University of California, San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Girard","sequence":"additional","affiliation":[{"name":"University of California, San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata C.","family":"Pereira","sequence":"additional","affiliation":[{"name":"University of California Los Angeles, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isidro B.","family":"Salusky","sequence":"additional","affiliation":[{"name":"University of California Los Angeles, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim H.","family":"Ix","sequence":"additional","affiliation":[{"name":"University of California, San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026052904350934000_2026.03.04.26347613v2.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2024.117329"},{"key":"2026052904350934000_2026.03.04.26347613v2.2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.12871211"},{"key":"2026052904350934000_2026.03.04.26347613v2.3","doi-asserted-by":"publisher","DOI":"10.1053\/ajkd.2000.19812"},{"key":"2026052904350934000_2026.03.04.26347613v2.4","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.E.01320"},{"key":"2026052904350934000_2026.03.04.26347613v2.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0883-5403(99)90079-7"},{"key":"2026052904350934000_2026.03.04.26347613v2.6","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2017.32.12.2035"},{"key":"2026052904350934000_2026.03.04.26347613v2.7","doi-asserted-by":"crossref","unstructured":"Sunday JM , Guille JT , Torg JS . 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