Intestinal calcium absorption is associated with bone mass in stone-forming women with idiopathic hypercalciuria

Vezzoli, Giuseppe; Rubinacci, Alessandro; Bianchin, Cristiana; Arcidiacono, Teresa; Giambona, Salvatore; Mignogna, Giovanna; Fochesato, Elena; Terranegra, Annalisa; Cusi, Daniele; Soldati, Laura

doi:10.1053/j.ajkd.2003.08.018

Cited by 36 publications

(36 citation statements)

References 28 publications

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“…As previously reported, several clinical observations have demonstrated decreased bone formation, increased bone resorption and reduced BMD in subjects with IHC [Heller et al 2007;Giannini et al 2003;Vezzoli et al 2003;Borghi et al 1991]. In general, this and other retrospective and prospective studies found that the rate of urine calcium excretion was related with bone loss and elevation of bone turnover markers in hypercalciuric patients, defining a link between IHC and bone disease [Vezzoli et al 2003;Tasca et al 2002;Giannini et al 1998;Bataille et al 1991;Sutton and Walker, 1986;Barkin et al 1985]. …”

Section: Methodssupporting

confidence: 65%

“…Several investigators, in the last 10 years, have reported increased bone turnover and reduced bone mineral density (BMD) in subjects with IHC [Heller et al 2007;Giannini et al 2003;Vezzoli et al 2003;Borghi et al 1991]. In addition, Melton and colleagues [Melton et al 1998] demonstrated, in a large population-based retrospective cohort study, a fourfold increase in the risk of vertebral fractures among patients with calcium kidney stones.…”

Section: Introductionmentioning

confidence: 99%

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Bisphosphonates in the management of idiopathic hypercalciuria associated with osteoporosis: a new trick from an old drug

Bianchi¹,

Giusti

Pioli³

et al. 2010

Therapeutic Advances in Musculoskeletal

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Idiopathic hypercalciuria (IHC) is defined as a 24-hour urinary calcium excretion that exceeds 4 mg/kg/day, regardless of gender and in absence of systemic diseases or pharmacological treatments that may cause normocalcemic hypercalciuria (eg sarcoidosis, normocalcemic primary hyperparathyroidism, vitamin D intoxication, hyperthyroidism). Patients with IHC and nephrolithiasis often present increased bone turnover, decreased bone mineral density (BMD) and increased susceptibility to fragility fractures. Although the pathogenesis of IHC seems complex and multifactorial, recent evidences suggest that cells involved in bone resorption may play a critical role in the chain of events leading to the excessive urinary calcium excretion. Therefore, it has been proposed that bisphosphonates, potent inhibitors of bone resorption, may have beneficial effects in hypercalciuric patients with low BMD. This manuscript reports recent findings regarding the role of bone tissue in the pathogenesis of IHC, and supports the use of bisphosphonates in such conditions. It also reviews the literature on the effects of bisphosphonates in subjects with osteoporosis-associated IHC.

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Section: Methodssupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Bisphosphonates in the management of idiopathic hypercalciuria associated with osteoporosis: a new trick from an old drug

Bianchi¹,

Giusti

Pioli³

et al. 2010

Therapeutic Advances in Musculoskeletal

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“…Previous findings showed higher strontium excretion and absorption in HSFs than in normocalciuric stone formers (14,15), consistent with the known alteration of calcium metabolism in these patients (5,10). In addition, strontium absorption was negatively correlated with lumbar BMD values in hypercalciuric stone-forming women (11). In this study, strontium absorption and excretion were compared in HSFs and HNSFs to find differences potentially explaining stone formation.…”

Section: Introductionmentioning

confidence: 97%

“…Decreased bone mineral density (BMD) may result from the negative balance between urine loss and enteral absorption of calcium (3,4). However, low BMD was associated with high calcium absorption and could be supported by a primary defect of calcium handling in intestinal, bony, and kidney tubular cells (7,11). Epidemiologic surveys also suggested that high serum levels of 25(OH)D and sodium intake may predispose to hypercalciuria (3,12), whereas serum levels of 1,25-dihydroxyvitamin D [1,25(OH) 2 D] were not found to be increased in hypercalciuric stone formers (HSFs) (13).…”

Section: Introductionmentioning

confidence: 99%

Intestinal Calcium Absorption among Hypercalciuric Patients with or without Calcium Kidney Stones

Vezzoli

Macrina

Rubinacci

et al. 2016

CJASN

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Background and objectives Idiopathic hypercalciuria is a frequent defect in calcium kidney stone formers that is associated with high intestinal calcium absorption and osteopenia. Characteristics distinguishing hypercalciuric stone formers from hypercalciuric patients without kidney stone history (HNSFs) are unknown and were explored in our study.Design, setting, participants, & measurements We compared 172 hypercalciuric stone formers with 36 HNSFs retrospectively selected from patients referred to outpatient clinics of the San Raffaele Hospital in Milan from 1998 to 2003. Calcium metabolism and lumbar bone mineral density were analyzed in these patients. A strontium oral load test was performed: strontium was measured in 240-minute urine and serum 30, 60, and 240 minutes after strontium ingestion; serum strontium concentration-time curve and renal strontium clearance were evaluated to estimate absorption and excretion of divalent cations.Results Serum strontium concentration-time curve (P,0.001) and strontium clearance (4.961.3 versus 3.562.7 ml/min; P,0.001) were higher in hypercalciuric stone formers than HNSFs, respectively. The serum strontiumtime curve was also higher in hypercalciuric stone formers with low bone mineral density (n=42) than in hypercalciuric stone formers with normal bone mineral density (n=130; P=0.03) and HNSFs with low (n=22; P=0.01) or normal bone mineral density (n=14; P=0.02). Strontium clearance was greater in hypercalciuric stone formers with normal bone mineral density (5.363.4 ml/min) than in hypercalciuric stone formers and HNSFs with low bone mineral density (3.662.5 and 3.162.5 ml/min, respectively; P=0.03). Multivariate regression analyses displayed that strontium absorption at 30 minutes was positively associated calcium excretion (P=0.03) and negatively associated with lumbar bone mineral density z score (P=0.001) in hypercalciuric stone formers; furthermore, hypercalciuric patients in the highest quartile of strontium absorption had increased stone production risk (odds ratio, 5.06; 95% confidence interval, 1.2 to 20.9; P=0.03).Conclusions High calcium absorption in duodenum and jejunum may expose hypercalciuric patients to the risk of stones because of increased postprandial calcium concentrations in urine and tubular fluid. High calcium absorption may identify patients at risk of bone loss among stone formers.

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“…Hypercalciuric stone formers have increased strontium absorption compared to normocalciuric patients. 10 Strontium is absorbed by the gut at a rate similar to that of calcium 11,12 and calcium absorption testing can be performed with strontium. 13 Therefore, strontium has long been used to study calcium metabolism in humans and evaluate differences in metabolism in patients with and without evidence of abnormal calcium processing, for example those with osteoporosis.…”

mentioning

confidence: 99%

2082 Strontium Substitution for Calcium in Lithogenesis

Blaschko¹,

Flechner²,

Snell

et al. 2012

Journal of Urology

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Purpose: Strontium has chemical similarity to calcium, which enables the replacement of calcium by strontium in biomineralization processes. Incorporating strontium into human bone and teeth has been studied extensively but little research has been performed of the incorporation of strontium into urinary calculi. We used synchrotron based x-ray fluorescence and x-ray absorption techniques to examine the presence of strontium in different types of human kidney stones. Materials and Methods: Multiple unique human stone samples were obtained via consecutive percutaneous nephrolithotomies/ureteroscopies. A portion of each stone was sent for standard laboratory analysis and a portion was retained for x-ray fluorescence and x-ray absorption measurements. X-ray fluorescence and x-ray absorption measurements determined the presence, spatial distribution and speciation of strontium in each stone sample. Results: Traditional kidney stone analyses identified calcium oxalate, calcium phosphate, uric acid and cystine stones. X-ray fluorescence measurements identified strontium in all stone types except pure cystine. X-ray fluorescence elemental mapping of the samples revealed co-localization of calcium and strontium. X-ray absorption measurements of the calcium phosphate stone showed strontium predominately present as strontium apatite. Conclusions: Advanced x-ray fluorescence imaging identified strontium in all calcium based stones, present as strontium apatite. This finding may be critical since apatite is thought to be the initial nidus for calcium stone formation. Strontium is not identified by standard laboratory stone analyses. Its substitution for calcium can be reliably identified in stones from multiple calcium based stone formers, which may offer opportunities to gain insight into early events in lithogenesis.

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Intestinal calcium absorption is associated with bone mass in stone-forming women with idiopathic hypercalciuria

Cited by 36 publications

References 28 publications

Bisphosphonates in the management of idiopathic hypercalciuria associated with osteoporosis: a new trick from an old drug

Bisphosphonates in the management of idiopathic hypercalciuria associated with osteoporosis: a new trick from an old drug

Intestinal Calcium Absorption among Hypercalciuric Patients with or without Calcium Kidney Stones

2082 Strontium Substitution for Calcium in Lithogenesis

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