Bone mineral density and urine calcium excretion among subjects with and without nephrolithiasis

Asplin, John R.; Bauer, Kimberly A.; Kinder, Jennifer M.; Müller, Georg; Coe, Brian J.; Parks, Joan H.; Coe, Fredric L.

doi:10.1046/j.1523-1755.2003.00763.x

Cited by 107 publications

(78 citation statements)

References 20 publications

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“…It is noteworthy that a similar finding was also reported by Tasca et al (14) and Vezzoli et al (12) in men under 65 years old. Previous studies reporting that 24-hour urine excretion was associated with bone-mass loss included female patients, suggesting that our results should not be extended to this population (15,24).…”

Section: Discussionmentioning

confidence: 66%

Determinants of Osteopenia in Male Renal-Stone–Disease Patients with Idiopathic Hypercalciuria

Letavernier¹,

Traxer²,

Daudon³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Bone demineralization is frequent in renal-stone formers with hypercalciuria. Although this pathologic link has been recognized for decades, the underlying mechanisms and risk factors associated with osteopenia/osteoporosis in this population remain partially understood.Design, setting, participants, & measurements This study retrospectively analyzed determinants of low bone mineral density (BMD) in 65 idiopathic hypercalciuric male renal-stone formers. Clinical and biologic evaluation included BMD measurement, bone-remodeling markers, analysis of calcium metabolism with oral calcium load test, and dietary inquiry.Results Patients with osteopenia (n ϭ 23, 35% of the population) presented significantly higher fasting calciuria as compared with normal bone density patients (n ϭ 42) (calcium/creatinine ratio was 0.32 versus 0.24 mmol/mmol; P ϭ 0.006). Analysis of the whole population revealed a negative association between fasting hypercalciuria and BMD (P ϭ 0.003), independent of confounding variables including body-mass index and tobacco consumption. The fasting calcium/creatinine ratio above 0.25 mmol/mmol was associated with a 3.8-fold increase in the risk of low BMD. ConclusionIn our study, fasting hypercalciuria after a 2-day calcium-restricted diet appears as the only biologic factor associated with low BMD, suggesting a bone-calcium efflux. Our results support the view of a parathyroid-independent pathologic process that remains to be identified. Hypercalciuric patients with low BMD do not excrete more calcium in 24-hour urine samples than patients without low BMD.

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Section: Discussionmentioning

confidence: 66%

Determinants of Osteopenia in Male Renal-Stone–Disease Patients with Idiopathic Hypercalciuria

Letavernier¹,

Traxer²,

Daudon³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…However, vitamin D repletion is likely to be of particular importance to stone formers, especially those patients with hypercalciuria. Not only is hypercalciuria an important risk factor for osteoporosis in the general population (11), but it also seems to be associated with even higher rates of bone loss among stone formers than nonstone formers (12).…”

Section: Discussionmentioning

confidence: 99%

Effect of Vitamin D Repletion on Urinary Calcium Excretion among Kidney Stone Formers

Leaf

Korets

Taylor

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Despite the important role of vitamin D in maintaining bone health, many clinicians are reluctant to treat vitamin D deficiency in kidney stone formers because of the theoretical risk of increasing urinary calcium excretion. This study examined the effect of vitamin D repletion on urinary calcium excretion among stone formers.Design, setting, participants, & measurements Participants (n=29) were recruited from urology clinics affiliated with New York Presbyterian Hospital. Enrollment criteria included a history of nephrolithiasis, urinary calcium excretion between 150 and 400 mg/d, and a serum 25-hydroxyvitamin D level ,30 ng/ml. Participants were given oral ergocalciferol (50,000 IU/wk) for 8 weeks. Serum and 24-hour urine tests were repeated after 8 weeks.Results Levels of 25-hydroxyvitamin D increased significantly after vitamin D repletion (1766 and 35610 ng/ml, P,0.001), but mean 24-hour urinary calcium excretion did not change (257654 and 255688 mg/d at baseline and follow-up, respectively, P=0.91). However, 11 participants had an increase in urinary calcium excretion $20 mg/d; these participants also had an increase in urine sodium excretion, likely reflecting dietary variability. No participant experienced adverse effects from vitamin D, including hypercalcemia.Conclusions Among stone formers with vitamin D deficiency, a limited course of vitamin D repletion does not seem to increase mean urinary calcium excretion, although a subset of individuals may have an increase. These data suggest that vitamin D therapy, if indicated, should not be withheld solely on the basis of stone disease, but 24-hour urinary calcium excretion should be monitored after repletion.

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“…USD is associated with increased risk of fracture, likely mediated by low BMD, which is most pronounced among women (5)(6)(7). Among women in their fourth decade of life, USD was associated with a 55% excess risk of fracture.…”

Section: Epidemiologymentioning

confidence: 99%

Urinary Stone Disease: Advancing Knowledge, Patient Care, and Population Health

Scales

Tasian

Schwaderer

et al. 2016

CJASN

137

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Expanding epidemiologic and physiologic data suggest that urinary stone disease is best conceptualized as a chronic metabolic condition punctuated by symptomatic, preventable stone events. These acute events herald substantial future chronic morbidity, including decreased bone mineral density, cardiovascular disease, and CKD. Urinary stone disease imposes a large and growing public health burden. In the United States, 1 in 11 individuals will experience a urinary stone in their lifetime. Given this high incidence and prevalence, urinary stone disease is one of the most expensive urologic conditions, with health care charges exceeding $10 billion annually. Patient care focuses on management of symptomatic stones rather than prevention; after three decades of innovation, procedural interventions are almost exclusively minimally invasive or noninvasive, and mortality is rare. Despite these advances, the prevalence of stone disease has nearly doubled over the past 15 years, likely secondary to dietary and health trends. The NIDDK recently convened a symposium to assess knowledge and treatment gaps to inform future urinary stone disease research. Reducing the public health burden of urinary stone disease will require key advances in understanding environmental, genetic, and other individual disease determinants; improving secondary prevention; and optimal population health strategies in an increasingly cost-conscious care environment.

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Bone mineral density and urine calcium excretion among subjects with and without nephrolithiasis

Cited by 107 publications

References 20 publications

Determinants of Osteopenia in Male Renal-Stone–Disease Patients with Idiopathic Hypercalciuria

Determinants of Osteopenia in Male Renal-Stone–Disease Patients with Idiopathic Hypercalciuria

Effect of Vitamin D Repletion on Urinary Calcium Excretion among Kidney Stone Formers

Urinary Stone Disease: Advancing Knowledge, Patient Care, and Population Health

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