Effects of Aminobisphosphonates and Thiazides in Patients With Osteopenia/Osteoporosis, Hypercalciuria, and Recurring Renal Calcium Lithiasis

Arrabal-Polo, Miguel Ángel; Arias‐Santiago, Salvador; Haro-Muñoz, Tomás de; Lopez-Ruiz, Adriana; Orgaz‐Molina, Jacinto; González-Torres, Samuel; Zuluaga-Gomez, Armando; Arrabal‐Martín, Miguel

doi:10.1016/j.urology.2012.12.013

Cited by 23 publications

(15 citation statements)

References 24 publications

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“…Moreover, preliminary experimental and clinical evidence suggests that therapeutic strategies aimed at targeting osteoporosis may have a favorable effect on both the metabolic urinary profile and VC (17,18). However, future prospective intervention trials will be needed to test the hypothesis that KSFs are a population at high risk of CVD and that this can be reduced by measures aimed at identifying and reducing VC and decreased BMD.…”

Section: Discussionmentioning

confidence: 99%

Vascular Calcification and Bone Mineral Density in Recurrent Kidney Stone Formers

Shavit

Girfoglio

Vijay

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Recent epidemiologic studies have provided evidence for an association between nephrolithiasis and cardiovascular disease, although the underlying mechanism is still unclear. Vascular calcification (VC) is a strong predictor of cardiovascular morbidity and the hypothesis explored in this study is that VC is more prevalent in calcium kidney stone formers (KSFs). The aims of this study were to determine (1) whether recurrent calcium KSFs have more VC and osteoporosis compared with controls and (2) whether hypercalciuria is related to VC in KSFs.Design, setting, participants, & measurements This is a retrospective, matched case-control study that included KSFs attending an outpatient nephrology clinic of the Royal Free Hospital (London, UK) from 2011 to 2014. Ageand sex-matched non-stone formers were drawn from a list of potential living kidney donors from the same hospital. A total of 111 patients were investigated, of which 57 were KSFs and 54 were healthy controls. Abdominal aortic calcification (AAC) and vertebral bone mineral density (BMD) were assessed using available computed tomography (CT) imaging. The prevalence, severity, and associations of AAC and CT BMD between KSFs and non-stone formers were compared.Results Mean age was 47614 years in KSFs and 47613 in non-stone formers. Men represented 56% and 57% of KSFs and non-stone formers, respectively. The prevalence of AAC was similar in both groups (38% in KSFs versus 35% in controls, P=0.69). However, the AAC severity score (median [25th percentile, 75th percentile]) was significantly higher in KSFs compared with the control group (0 [0, 43] versus 0 [0, 10], P,0.001). In addition, the average CT BMD was significantly lower in KSFs (159653 versus 194 648 Hounsfield units, P,0.001). A multivariate model adjusted for age, sex, high BP, diabetes, smoking status, and eGFR confirmed that KSFs have higher AAC scores and lower CT BMD compared with non-stone formers (P,0.001 for both). Among stone formers, the association between AAC score and hypercalciuria was not statistically significant (P=0.86).Conclusions This study demonstrates that patients with calcium kidney stones suffer from significantly higher degrees of aortic calcification than age-and sex-matched non-stone formers, suggesting that VC may be an underlying mechanism explaining reported associations between nephrolithiasis and cardiovascular disease. Moreover, bone demineralization is more prominent in KSFs. However, more data are needed to confirm the possibility of potentially common underlying mechanisms leading to extraosseous calcium deposition and osteoporosis in KSFs.

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Section: Discussionmentioning

confidence: 99%

Vascular Calcification and Bone Mineral Density in Recurrent Kidney Stone Formers

Shavit

Girfoglio

Vijay

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…6 The UCa/Cr has been found to be strongly correlated with 24 h urinary calcium excretion. 7 Increased urine uric acid and protein tubulopathy was defined as a urine uric acid to creatinine ratio >0.8 and urine protein to creatinine ratio >0.3, respectively. 8 Non-iodinated contrast renal tract CT was performed using the Discovery CT750 HD system with Gemstone Spectral Imaging (GE Healthcare, Milwaukee, WI, USA).…”

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confidence: 99%

Urolithiasis is prevalent and associated with reduced bone mineral density in β‐thalassaemia major

Wong

Milat

Fuller

et al. 2017

Internal Medicine Journal

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Asymptomatic urolithiasis is common and of mixed composition in patients with β-thalassaemia major. Twenty-seven subjects were imaged using dual-energy computer tomography to determine the presence and composition of urolithiasis. The prevalence of urolithiasis was 59% and affected patients generally had multiple stones, often with more than one component: struvite (33%), calcium oxalate (31%) and cystine (22%). Hypercalciuria was present in 78% of subjects and calcium-containing urolithiasis was associated with reduced femoral neck Z scores.

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“…Thus, it seems that in the treatment of calcium stones associated with a loss of bone mineral density, a new horizon is opened, not only in the improvement of bone mineral density, but also in the decrease in urinary calcium. It is for this reason that some studies have previously analyzed the effect of these drugs on their own or in combination with thiazides, observing that the urinary calcium is decreased more with the combination, and that there is an improvement in bone mineral density at least not inferior to the treatment with bisphosphonates only [11,27]. In our study, the patients of Group 2 treated with a combination obtained an improvement in bone mineral density similar to Group 1 (alendronate only) and a similar decrease in urinary calcium as the patients of Group 3 (treated with hydrochlorothiazide only).…”

Section: Discussionmentioning

confidence: 99%

“…Based on the previous experience of our group in the treatment of patients with calcium stones and osteopenia/osteoporosis with bisphosphonates, combined or not with thiazides [11], the aim of this work is to prospectively analyze the effects of treatment with alendronate, hydrochlorothiazide, and alendronate + hydrochlorothiazide in patients with recurring calcium kidney stones after a 2-year follow-up period.…”

Section: Introductionmentioning

confidence: 99%

Urine Calcium and Bone Mineral Density in Calcium Stone-Forming Patients Treated with Alendronate and Hydrochlorothiazide

et al. 2016

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Introduction: The objective was to evaluate the effect of hydrochlorothiazide and alendronate on urine calcium and bone mineral density in calcium stone-forming patients. Material and Methods: A prospective, non-randomized, non-observational comparative study was performed; this study included 111 patients with recurrent calcium stones, divided into 3 groups according to the treatment received. Group 1: 36 patients were treated with alendronate, 70 mg/week; Group 2: 34 patients were treated with alendronate, 70 mg/week + hydrochlorothiazide, 50 mg/day; Group 3: 41 patients were treated with hydrochlorothiazide, 50 mg/day. All patients received recommendations on diet and fluid intake. Other variables of bone mineral density were studied and analyzed, including bone remodeling markers and urinary calcium before and after 2 years of treatment. The statistical analysis was performed using the SPSS 17.0 program, with a statistical significance of p < 0.05. Results: After 2 years of treatment, a significant difference was observed in the β-crosslaps and a bone mineral density improvement in Group 1, along with a decrease in urinary calcium. In Group 3, a statistically significant difference was found in urinary calcium and fasting calcium/creatinine ratio, as well as an improvement in bone mineral density after 2 years of medical treatment. In Group 2 patients treated with the combination, there was an improvement in bone mineral density and a decrease in the β-crosslaps marker similar to patients in Group 1, and a decrease in urinary calcium similar to those in Group 3. Conclusion: Combined alendronate + hydrochlorothiazide treatment offers the best results along with the improvement in bone mineral density and decrease in urine calcium in patients with recurrent calcium stones.

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Effects of Aminobisphosphonates and Thiazides in Patients With Osteopenia/Osteoporosis, Hypercalciuria, and Recurring Renal Calcium Lithiasis

Cited by 23 publications

References 24 publications

Vascular Calcification and Bone Mineral Density in Recurrent Kidney Stone Formers

Vascular Calcification and Bone Mineral Density in Recurrent Kidney Stone Formers

Urolithiasis is prevalent and associated with reduced bone mineral density in β‐thalassaemia major

Urine Calcium and Bone Mineral Density in Calcium Stone-Forming Patients Treated with Alendronate and Hydrochlorothiazide

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