Osteoporosis and Urolithiasis

Caudarella, Renata; Vescini, Fabio; Buffa, Angela; Manna, Gaetano La; Stefoni, S

doi:10.1159/000076585

Cited by 50 publications

(48 citation statements)

References 27 publications

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“…Patient 3 was treated initially with IV Zoledronic acid but was subsequently switched to oral alendronate due to one short-lived episode of hypocalcemic tetany. In four patients (1,4,5,7), previous pharmacologic anticalciuric treatment was continued. No adverse effects were recorded during the treatment with alendronate.…”

Section: Resultsmentioning

confidence: 99%

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Bisphosphonates in children with hypercalciuria and reduced bone mineral density

Freundlich

Alon

2008

Pediatr Nephrol

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Previous studies have demonstrated reduced bone mineral density (BMD) and biochemical changes of excessive bone resorption in some patients with idiopathic hypercalciuria (IH). Consequently, bisphosphonates have been successfully employed in research animals and adults with IH and reduced BMD. We evaluated the effect of treatment with bisphosphonates in seven patients ages 10-16 years with persistent IH and reduced BMD. In five children, preceding traditional therapy failed. All children received oral alendronate and one also IV Zoledronic acid for 6-18 (median 9.0, mean 10.7) months. With treatment, BMD Z scores in the lumbar spine improved from -2.0 +/- 0.3 to -0.8 +/- 0.8 (p = 0.002) and in the femoral neck from -1.8 +/- 0.4 to -0.7 +/- 0.9 (p = 0.01); urine N-telopeptides/creatinine decreased from 372 +/- 289 to 72 +/- 39 nmol/mmol (p = 0.05) and calcium/creatinine from 0.29 +/- 0.12 to 0.13 +/- 0.06 mg/mg (p = 0.009). Height Z scores, normal at baseline in all, remained unaffected, and no new stones or fractures were documented throughout the treatment period. Serum creatinine, electrolytes, calcium, phosphorus and parathyroid hormone remained normal as well. In summary, in children with IH and decreased BMD, treatment with bisphosphonates normalized urine calcium excretion, eliminated urinary symptoms, and significantly improved reduced BMD. These short-term beneficial effects indicate the need for larger prospective studies on the potential of bisphosphonates to serve as a new tool in treating children with IH and reduced BMD.

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Section: Resultsmentioning

confidence: 99%

“…In adults, the association of hypercalciuria with osteopenia is well established [4][5][6][7]. In those with severe osteopenia, Jaeger et al [8] found significantly higher incidence of fractures.…”

Section: Introductionmentioning

confidence: 99%

Bisphosphonates in children with hypercalciuria and reduced bone mineral density

Freundlich

Alon

2008

Pediatr Nephrol

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“…Reduced bone mass and high risk for osteoporotic fractures as a consequence of PTH and vitamin D abnormalities have also been documented in calcium stone formers [12,13,14,15], as well as a contributing role of FGF-23 and KLOTHO gene polymorphism in the pathogenesis of calcium nephrolithiasis [16,17]. Therefore, FGF-23 and KLOTHO are likely to influence the vitamin D status in this patient population.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Status in Patients with Recurrent Kidney Stones

Pipili

Oreopoulos²

2013

Nephron Clin Pract

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Data regarding the prevalence of 25-hydroxyvitamin D (25(OH)D) insufficiency in patients with nephrolithiasis, and the effects of vitamin D supplementation on parathyroid hormone (PTH) are few and conflicting. In this article, we examined the prevalence of vitamin D insufficiency and deficiency in 236 recurrent kidney stone formers and the correlation of vitamin D levels with other parameters of stone formation. The prevalent stone composition was calcium oxalate (80.4%) and uric acid (16.45%). One third of stone formers had vitamin D insufficiency and a quarter of them high PTH levels (PTH >7.5 pmol/l) with normal serum (total and ionized) calcium values. Predictor of high PTH was low 25(OH)D level (r = 0.989, r² = 0.977, p < 0.001). Stone formers with hypercalciuria had higher 25(OH)D values (72.26 ± 4.21 vs. 59.29 ± 1.76, p = 0.0013) compared to stone formers with urine calcium within normal ranges. Further studies are needed in order to better define the consequences of vitamin D insufficiency and to evaluate the impact of the therapeutic interventions in this cohort.

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“…The use of thiazides is not always sufficient, as it has been demonstrated that a high percentage of patients with recurrent renal calcium stones have an osteopenia/osteoporosis [20,21,22] that could benefit from treatment with an anti-reabsorption drug. The bisphosphonates are a group of therapeutic drugs widely used in the treatment of osteoporosis [23], although they are not free of adverse effects, one of the most severe being osteonecrosis of the jaw.…”

Section: Discussionmentioning

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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Osteoporosis and Urolithiasis

Cited by 50 publications

References 27 publications

Bisphosphonates in children with hypercalciuria and reduced bone mineral density

Bisphosphonates in children with hypercalciuria and reduced bone mineral density

Vitamin D Status in Patients with Recurrent Kidney Stones

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

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