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The bone and beyond

'Dem bones' are made for more than walking

Nature Medicine volume 17, pages 428–430 (2011)Cite this article

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Bone is an endocrine organ that reaches out to other tissues, orchestrating responses that may have a role in pathology and physiology at distant sites. In 'Bench to Bedside', L. Darryl Quarles discusses recent studies showing how a feedback loop between the bone hormone FGF-23 and renal phosphate excretion and vitamin D metabolism is integrated with the classical PTH–vitamin D axis in chronic kidney disease (CKD). This new paradigm may change the diagnosis and treatment of disordered mineral homeostasis of people with CKD. A recent epidemiological study argues a mechanistic link between bone loss and atherosclerosis, maladies usually linked to aging. In 'Bedside to Bench', Sundeep Khosla discusses how this clinical study underpins research showing that mediators of inflammation and oxidative stress share common mechanisms that may lead to this calcium shift during aging.

Bone is a metabolically active tissue regulated by multiple hormones that control formation and resorption to maintain bone mass and mineral homeostasis. But bone is also an endocrine organ that secretes osteocalcin to regulate glucose homeostasis and energy metabolism by targeting G protein–coupled receptor family C group 6 member A (GPRC6A) in beta cells and other tissues1, and fibroblast growth factor-23 (FGF-23), which is a recently discovered phosphate- and vitamin D–regulating hormone2.

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Figure 1: Abnormalities in the FGF-23–parathyroid hormone–vitamin D endocrine network in CKD.

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  1. L. Darryl Quarles is at The University of Tennessee Health Science Center, Memphis, Tennessee, USA.,

    L Darryl Quarles

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  1. L Darryl Quarles
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Correspondence to L Darryl Quarles.

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Competing interests

L.D.C. is a consultant to Amgen, KAI Pharmaceuticals and Shire. He has also been a paid speaker for Amgen.

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Quarles, L. 'Dem bones' are made for more than walking. Nat Med 17, 428–430 (2011). https://doi.org/10.1038/nm0411-428

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