Relationship between ALPHA klotho protein and factors affecting bone mineral density reduction in men 60 YEARS and over

Aim: Osteoporosis is a progressive metabolic bone disease that results in an increased risk of fracture as a result of decreased bone mass and deterioration of the micro-architecture of bone tissue. It has a silent course until fracture occurs. There are various studies on the factors affecting bone mineral density (BMD); the relationship between Klotho protein and BMD is unclear. The first aim of the study is to determine whether there is an independent relationship between Klotho and BMD in men, and the second aim is to determine other factors affecting BMD. Materials and Methods: A total of 140 male patients were included in the study, which was planned as a case-control study. Osteoporosis and osteopenia groups were defined according to the definition of the World Health Organization (WHO). Sarcopenia was defined according to the criteria of the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Within the scope of the study, bone densitometry measurement, anthropometric measurements, laboratory tests and comprehensive geriatric assessment tests were applied to the patients. Physical performance was measured with the 4-meter walking test, muscle strength was measured with the hand dynamometer, and muscle mass was measured with bioimpedance. In addition to the routine laboratory tests, the serum alpha Klotho protein level was measured and compared between the groups. Results: A total of 140 male patients aged 60 years and older were included in the study. There were 60 patients in the control group and 80 patients in the case group with decreased BMD. Alpha Klotho levels were found to be 0.42±0.47 ng/ml in the control group and 0.34±0.26 ng/ml in the case group, and there was no statistically significant difference between the two groups (p =0.817). The number of patients diagnosed with atherosclerotic heart disease, Diabetes Mellitus and chronic obstructive pulmonary disease (COPD) was higher in the control group and it was found to be statistically significant. A significant correlation was found between sarcopenia screening tests and BMD, which is one of the geriatric tests of the participants. While uric acid and monocyte levels were low in the case group; total testosterone, osteocalcin, LDL, total cholesterol and potassium levels were found to be significantly higher. Muscle mass (p=0.002), waist circumference, upper arm and calf circumference were found to be significantly lower in the case group. In our study, the mean Klotho level was found to be lower in those diagnosed with Diabetes Mellitus, hypertension, and chronic kidney disease, and no significant difference was detected. Conclusions: In this study, no statistically significant correlation was found between the decrease in BMD and the level of alpha Klotho protein. Muscle mass was also found to be significantly lower in the group with reduced BMD, supporting osteosarcopenia. Prospective observational studies with a large number of patients are needed. Keywords: male osteoporosis, sarcopenia, bone mineral density, osteosarcopenia, Klotho