Prevention of Stone Formation and Bone Loss In Absorptive Hypercalciuria by Combined Dietary and Pharmacological Interventions

Pak, Charles Y.C.; Heller, Howard J.; Pearle, Margaret S.; Odvina, Clarita V.; Poindexter, John R.; Peterson, Roy D.

doi:10.1097/00005392-200302000-00006

Cited by 22 publications

(30 citation statements)

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“…In hypercalciuric osteopenic adults, both thiazide diuretics and K citrate were previously demonstrated to be effective in simultaneously reversing hypercalciuria and improving reduced BMD [25][26][27][28]. Reusz et al [29] studied 18 children with IH and showed the beneficial effect of thiazide therapy on BMD.…”

Section: Discussionmentioning

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: Discussionmentioning

confidence: 99%

“…Although not completely free from potential adverse effects, the long-term safety records of thiazides and K citrate are excellent [28,32]. In contrast, the long-term safety of bisphosphonates and in particular the effect of their long-term accumulation in the growing bone remains unknown [33][34][35][36].…”

Section: Discussionmentioning

confidence: 99%

Bisphosphonates in children with hypercalciuria and reduced bone mineral density

Freundlich

Alon

2008

Pediatr Nephrol

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“…not only averts diuretic-induced hypokalemia, but increases urinary citrate. Among patients with absorptive hypercalciuria, this pharmacologic intervention combined with dietary modification of restriction of calcium, oxalate and sodium, has been shown to prevent stone formation as well as to stabilize or increase bone density [16]. …”

Section: Pharmacologic Interventionmentioning

confidence: 99%

Medical Management of Urinary Stone Disease

Pak¹

2004

Nephron Clin Pract

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A variety of dietary and metabolic factors may contribute or cause stone formation in idiopathic calcium oxalate nephrolithiasis. Dietary factors include a high intake of animal proteins, oxalate and sodium, and a low intake of fluids and potassium-containing citrus products. Some of the metabolic causes of stones are hypercalciuria, hypocitraturia, gouty diathesis, hyperoxaluria, and hyperuricosuria. Dietary modification, to be applied in all patients with stones includes a high fluid intake, restriction of oxalate and sodium, and balanced diet with animal proteins complemented by adequate intake of fruits and vegetables. When dietary modification is ineffective in controlling stone formation or in the presence of severe metabolic derangements, a pharmacologic intervention may be necessary. In a simple approach, thiazide or indapamide with potassium citrate is recommended for patients with hypercalciuria, and potassium citrate alone for the remaining normocalciuric subjects.

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“…Studies in children have not conclusively demonstrated a clear difference between the different subtypes of HC (resorptive, renal, and absorptive), overcoming classification modifications in the same children over the years [14]. Patients with resorptive HC present major bone damage, but this is present also in the other subtypes [36,37]. For this reason, we were interested in evaluating children with any subtype of IHC, and therefore we used a general protocol for HC diagnosis without performing specific tests to determine the different pathophysiological subtypes described within IHC.…”

Section: Discussionmentioning

confidence: 99%

Reduced Bone Mass in 7-Year-Old Children with Asymptomatic Idiopathic Hypercalciuria

Escribano

Rubio-Torrents²,

Ferré

et al. 2014

Ann Nutr Metab

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Background: Idiopathic hypercalciuria (IHC), i.e. an elevated urinary calcium excretion without concomitant hypercalcemia, is a common disorder in children and can have a range of urinary clinical presentations and decreased bone mineral density (BMD). Aim: To assess the effect of IHC on bone mineral content in children without urological symptoms. Methods: Calcium excretion, BMD (by dual-energy X-ray absorptiometry), and anthropometry were assessed in 175 seven-year-old children who were classified as IHC or controls. Calcium intake and physical activity were measured as confounding factors. Results: The prevalence of IHC was 17.7%. Both groups (controls and IHC) showed similar baseline characteristics in terms of their anthropometry, gender distribution, and protein and calcium dietary intakes as well as physical activity scores. Urinary calciuria was independent of the calcium dietary intake and anthropometry. BMD correlated with anthropometry and physical activity but not with calcium dietary intake. IHC children had lower whole-body BMD z-scores compared to controls. The role of IHC in reducing the whole-body BMD z-score was still significant even when anthropometry, physical activity, and calcium intake were included as confounders in multivariate analyses. Conclusions: The prevalence of IHC in this population of 7-year-old children was about 17%. IHC diagnosis was associated with lower BMD z-scores and osteopenia in 22% of them.

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Prevention of Stone Formation and Bone Loss In Absorptive Hypercalciuria by Combined Dietary and Pharmacological Interventions

Cited by 22 publications

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Bisphosphonates in children with hypercalciuria and reduced bone mineral density

Bisphosphonates in children with hypercalciuria and reduced bone mineral density

Medical Management of Urinary Stone Disease

Reduced Bone Mass in 7-Year-Old Children with Asymptomatic Idiopathic Hypercalciuria

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