Vitamin D and Calcium Supplementation and Urolithiasis: A Controversial and Multifaceted Relationship

Abstract

Patients with urolithiasis, and particularly those with hypercalciuria, frequently have a marked reduction of bone mineral content up to the levels of osteoporosis, with a significant increase in bone fracture risk. For these reasons, the indication to prescribe vitamin D and/or calcium supplementations is very frequent in such patients. On the other hand, both calcium supplementation, and even more vitamin D therapy, can worsen the risk of developing urolithiasis by increasing calcium, phosphate, and oxalate urinary excretion. Despite the clinical and practical relevance of this issue, the evidence on this topic is scarce and contradictory. Therefore, some concerns exist about how and whether to prescribe such supplements to a patient with a history of kidney stones. In this narrative review, we resume some pivotal pathophysiological concepts strictly related to the dealt topic, and we draw some considerations and personal opinions on the pros and cons of such prescriptions. Finally, we share with the reader our pragmatic algorithm for handling the urolithiasis risk in patients who have strong indications to be prescribed vitamin D and calcium supplementations.

Association between milk consumption and kidney stones in U.S. adults: results from NHANES 2007–2018

“…The most common stone phenotype is calcium-based, and the pathogenesis of kidney stones may be associated with metabolic pathways of calcium and vitamin D ( 13 ). However, studies on the relationship between the two and kidney stones are controversial ( 27 ). Previously, numerous prospective studies have indicated a strong correlation between increased dietary calcium intake and a decreased risk of kidney stones, a trend that is in line with our own findings ( 14–18 ).…”