Bone mineral content in calcium renal stone formers

Trinchieri, Alberto

doi:10.1007/s00240-005-0498-y

Cited by 25 publications

(25 citation statements)

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“…First, the tightly regulated conversion of 25(OH)D to 1,25(OH) 2 D by 25-hydroxyvitamin D-1a-hydroxylase (CYP27B1) may have limited synthesis of the active form, thereby preventing excessive intestinal calcium reabsorption. Second, an increase in intestinal calcium reabsorption did occur but did not increase urinary calcium excretion, because the additional calcium was deposited in bone to restore bone mineral content (13).…”

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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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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“…Calcium dietary intake is frequently reduced in stone formers, carrying out a negative calcium balance that contributes to BMD depletion [12,13]. In this context, calcium supplementation remains controversial.…”

Section: Discussionmentioning

confidence: 99%

“…First, the presence of hypercalciuria appears to play a relevant role in predisposing to bone demineralization [7][8][9]. Hypercalciuria is associated with important alterations in calcium-phosphate homeostasis [10], persistent overproduction of cytokines predisposing bone loss [11], parathormone (PTH), and calcitriol-mediated pathways [12]. Furthermore, as observed in some studies, subjects with nephrolithiasis may limit their dietary calcium intake, resulting in a negative calcium balance that predisposes the individual to a higher risk of bone loss over time [13,14].…”

Section: Introductionmentioning

confidence: 99%

Nephrolithiasis, bone mineral density, osteoporosis, and fractures: a systematic review and comparative meta-analysis

et al. 2016

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“…18 In fact, treatment with alkalinizing agents, such as potassium citrate, for 1 year has been shown to significantly increase BMD at the vertebral spine, femoral neck and total hip in postmenopausal woman with osteopenia. 19 Another hypothesis is a defect in vitamin D regulation with either high circulating levels of 1,25 vitamin D or increased bone tissue sensitivity to vitamin D. 20 In the present study, vitamin D stores and VDI were assessed by measuring serum 25(OH) vitamin D levels. There was no significant difference in median serum VD levels between patients with normal and abnormal Z-scores (18.6 vs. 18.8 ng/mL, p = 0.53).…”

Section: Bmd In Urolithiasis Patients With Vitamin D Inadequacymentioning

confidence: 99%

“…Yet others have hypothesized that calcium restriction advice in the past may have contributed to the negative calcium balance since idiopathic renal calcium stone-formers with low BMD have significantly lower calcium intake when compared with calcium stone-formers with normal BMD. [17][18][19][20][21][22] Recently, evidence from the NHANES III study showed that in men with history of urolithiasis, milk consumption was associated more strongly with femoral neck BMD than for men without history of urolithiasis. 5 While patients with osteoporosis are at higher risk of fractures, most (82%) fractures occur in patients with osteopenia.…”

Section: Bmd In Urolithiasis Patients With Vitamin D Inadequacymentioning

confidence: 99%

Bone mineral density status in urolithiasis patients with vitamin D inadequacy followed at a tertiary stone centre

Elkoushy

Jundi

Lee

et al. 2014

CUAJ

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Introduction: We assessed abnormalities in bone mineral density (BMD) and the risk of hip and major osteoporotic fractures in urolithiasis patients with vitamin D inadequacy (VDI) followed at a tertiary stone centre. Methods: Stone-free patients with VDI were invited to undergo dual-energy x-ray absorptiometry (DXA) scans to assess for BMD abnormalities at the femoral neck and lumbar spine. The World Health Organization's validated Fracture Risk Assessment Tool (FRAX) was used to calculate the risk of hip and major osteoporotic fractures within 10 years. Patients with primary hyperparathyroidism or hypercalcemia were excluded. Results: In total, 50 consecutive patients were included between June 2011 and August 2012, including 26 (52%) males. The median age was 51 years and the median 25-hydroxyl vitamin D (25[OH] D) was 18.8 ng/mL. Thirty patients (60%) had abnormal T-scores on DXA studies. This decreased to 22 (44%) when age-matched Z-scores were used; 36% had osteopenia and 8% had osteoporosis. Femoral neck and lumbar spines were affected in 24% and 32% of patients, respectively. Recurrent stone-formers had significantly lower BMD when compared with first-time stone formers. Median serum 25(OH)D was comparable between patients with normal and abnormal DXA scans (18.6 vs. 18.8 ng/mL; p = 0.91). Five patients (10%) were at high risk (≥3%) of hip fractures within 10 years. Conclusion: A high prevalence of abnormal DXA scans was found in urolithiasis patients with VDI, including 5 patients (10%) at high risk of hip fractures. Future studies need to assess the economic impact of obtaining DXA scans on urolithiasis patients with VDI, especially in recurrent stone-formers. IntroductionOsteoporosis is the most common bone disease globally.1 By 2020, it is estimated that 14 million individuals over 50 years will develop osteoporosis and another 47 million will have osteopenia in the United States alone.1 Furthermore, osteoporosis is the most common cause of fractures, accounting for 1.5 million yearly fractures in the United States.1 In addition to the associated physical and mental morbidities of osteoporotic fractures to individuals, it is estimated that 12 to 18 billion dollars are spent per year as annual direct care costs to treat such osteoporotic fractures; this cost exceeds costs related to heart disease, stroke and breast cancer. Therefore, osteoporosis has an impact on global health and it is important to identify patients at risk of osteoporotic fractures and institute appropriate preventive measures.Several population-based cohort studies have examined the relationship of urolithiasis and osteoporosis.3-5 However, most of the studies were conducted before the introduction of Z-scores based on the dual-energy x-ray absorptiometry (DXA) scan, which is the current gold standard to evaluate osteoporosis and assess fracture risk according to the World Health Organization (WHO). 6 In addition, none of these studies examined the role of vitamin D inadequacy (VDI) in these patients. Vitamin D plays a vital...

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Bone mineral content in calcium renal stone formers

Cited by 25 publications

References 70 publications

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

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

Nephrolithiasis, bone mineral density, osteoporosis, and fractures: a systematic review and comparative meta-analysis

Bone mineral density status in urolithiasis patients with vitamin D inadequacy followed at a tertiary stone centre

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