The effects of menopause and estrogen replacement therapy on the renal handling of calcium

Adami, Silvano; Gatti, Davide; Bertoldo, Francesco; Rossini, Maurizio; Fratta-Pasini, Anna; Zamberlan, N.; Facci, E; Cascio, Vincenzo Lo

doi:10.1007/bf01623924

Cited by 55 publications

(38 citation statements)

References 26 publications

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“…This finding is in agreement with previous studies that have shown an effect of exogenous estrogen to regulate renal phosphate handling in women (1,26) and animals (10). As discussed above, although the total estradiol concentration was not associated with modulation of renal phosphate handling, the simplest explanation for the effects of SHBG and albumin is that it is their combined effect on the free estradiol concentration that is the physiologically important parameter.…”

Section: Discussionsupporting

confidence: 83%

Effects of endogenous estrogen on renal calcium and phosphate handling in elderly women

Dick¹,

Devine²,

Beilby³

et al. 2005

American Journal of Physiology-Endocrinology and Metabolism

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are an important determinant of preservation of bone mass and reduced fracture in elderly women. Calcium supplementation can also reduce bone loss in these patients, suggesting an interaction between estrogen deficiency and calcium balance. Potential mechanisms of estrogen on calcium transport include direct effects on the bone, the kidney, and the bowel. Previous studies have demonstrated effects of estrogen on renal phosphate handling. We have used a cross-sectional, population-based analysis of biochemical data obtained from ambulant elderly women to determine the association of endogenous estradiol with urine calcium and phosphorus excretion. The subjects were 293 postmenopausal women Ͼ70 yr old. Factors associated with renal calcium and phosphate excretion were measured, including the filtered calcium and phosphate load, parathyroid hormone (PTH), estradiol, and sex hormone-binding globulin (SHBG). The free estradiol concentration (FE) was calculated from a previously described formula. A high plasma estradiol concentration (r 2 ϭ 0.023, P ϭ 0.01) and a high FE (r 2 ϭ 0.045, P ϭ 0.001) were associated with reduced renal calcium excretion. The estradiol and FE effect on renal calcium excretion remained significant after adjusting for calcium filtered at the glomerulus and serum PTH. A high FE was associated with a reduced renal phosphate threshold in univariate analysis (r 2 ϭ 0.023, P ϭ 0.010). The effect remained significant after adjustment for serum PTH. The size of the effect of the FE was of the same order of magnitude as the effect of PTH on reducing renal calcium excretion and increasing renal phosphate excretion. These data support in vitro and animal data demonstrating an effect of estradiol on renal calcium and phosphate handling and indicate that, in elderly postmenopausal women, the effect is of a similar magnitude to the well-recognized effects of PTH on these physiologically regulated parameters. estradiol; calcium homeostasis; phosphate homeostasis; renal tubular calcium reabsorption; osteoporosis CORRELATION STUDIES EXAMINING the relationship between circulating estrogen concentrations and bone density have produced a significant amount of evidence to suggest that falling concentrations of estrogen at the menopause are associated with low bone density (3,27,29). This accelerated loss of bone can result in osteoporotic fracture, which affects Ն50% of elderly postmenopausal women (11,12,17). Reports from the Study of Osteoporotic Fracture study have shown an association between low estradiol concentrations and reduced bone density (32) and an increased rate of hip, but not spine, fracture (7). The EPIDOS (Epidémiologie de l'ostéoporose) study was also able to show an effect of low estrogen concentrations on hip fracture in elderly French women that was accounted for by differences in body weight, suggesting that fat mass was the source of endogenous estrogen (4). These studies support the hypothesis that endogenous estrogen concentrations in elderly postmenopausal women have an important physi...

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Section: Discussionsupporting

confidence: 83%

Effects of endogenous estrogen on renal calcium and phosphate handling in elderly women

Dick¹,

Devine²,

Beilby³

et al. 2005

American Journal of Physiology-Endocrinology and Metabolism

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“…In women matched for serum ionized calcium, Nordin et al (6) found that fasting urinary calcium excretion was 50% higher (P Ͻ 0.001) in postmenopausal women compared with premenopausal women. Similar differences in urinary calcium excretion between premenopausal and postmenopausal women were found in an unmatched study (7). Estrogen deficiency increases the sensitivity of bone to parathyroid hormone, leading to a net increase in bone resorption and increased urinary calcium excretion (14).…”

Section: Discussionmentioning

confidence: 76%

“…Menopause is associated with an increase in urinary calcium excretion (6,7), which may increase the risk for calciumcontaining stone formation. In subjects matched for serum total and ionized calcium levels, urinary calcium excretion was 50% higher (P Ͻ 0.001) in postmenopausal women compared with premenopausal women (6).…”

mentioning

confidence: 99%

Menopause and Postmenopausal Hormone Use and Risk of Incident Kidney Stones

Kramer¹,

Grodstein²,

Stampfer³

et al. 2003

Journal of the American Society of Nephrology

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Abstract. Menopause is associated with increased urinary calcium excretion, which could increase the risk for the development of calcium-containing kidney stones. However, it is unknown whether menopause and postmenopausal hormone (PMH) use are independent risk factors for incident kidney stone disease in women. Data from 91,731 female Nurses' Health Study participants who provided information on diet, menopause status, and kidney stone disease were used to examine the independent association between menopause and PMH use and risk of incident kidney stones. No association was found between menopause and incident kidney stones in age-adjusted (relative risk [RR], 1.07; 95% CI, 0.85 to 1.34) or multivariate models (RR, 1.12; 95% CI, 0.89 to 1.41). However, when the association between the type of menopause and risk of incident kidney stones was examined, surgical menopause was associated with an increased risk in both the ageadjusted (RR, 1.37; 95% CI, 1.05 to 1.77) and multivariate models (RR, 1.39; 95% CI, 1.07 to 1.81), whereas natural menopause was not. Compared with never-use, past or current PMH use (including duration of PMH use) was not associated with incident kidney stones among postmenopausal women. In conclusion, no association was found between menopause and PMH use and incident kidney stones. Surgical menopause, however, may be associated with an increased risk.Approximately 5% of all women living in the United States will experience the passage of a kidney stone before the age of 70 yr (1). The passage of a kidney stone is very painful, and the costs incurred due to treatment, morbidity, and time lost from work are substantial (2). Increased urinary calcium excretion is an important risk factor for the development of calcium-containing kidney stones (3), which account for over 80% of all kidney stones in the United States (4). Compared with urinary calcium concentrations Ͻ 75 mg/L, the relative risk for kidney stones increased from twofold in subjects with urinary calcium 100 to 149 mg/L to over fourfold in subjects with Ն 200 mg/L (5). Thus, even moderate increases in urinary calcium excretion may substantially increase the risk for stone formation.Menopause is associated with an increase in urinary calcium excretion (6,7), which may increase the risk for calciumcontaining stone formation. In subjects matched for serum total and ionized calcium levels, urinary calcium excretion was 50% higher (P Ͻ 0.001) in postmenopausal women compared with premenopausal women (6). Thus, the onset of menopause may increase urinary calcium excretion and the risk for kidney stone formation. In contrast, postmenopausal hormone (PMH) use has been shown to decrease fasting urinary calcium by 50% compared with baseline in postmenopausal women (8). It is currently not known whether menopause and PMH use are independent risk factors for kidney stone formation in women. The aim of this study was to prospectively study the independent association among menopause, PMH use, and risk of incident kidney stones in women. Materia...

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“…cholecalciferol in the kidney [415] and synthesis of sorption declines because estradiol withdrawal reduces renal sensitivity to PTH [419] and leads to cholecalciferol receptors in the duodenum. [416] reduced renal cholecalciferol production.…”

Section: Endocrine Influences Over Bone Mass Mass Of Normal-weight Prmentioning

confidence: 99%

Physical Activity in the Prevention and Amelioration of Osteoporosis in Women

2005

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The effects of menopause and estrogen replacement therapy on the renal handling of calcium

Cited by 55 publications

References 26 publications

Effects of endogenous estrogen on renal calcium and phosphate handling in elderly women

Effects of endogenous estrogen on renal calcium and phosphate handling in elderly women

Menopause and Postmenopausal Hormone Use and Risk of Incident Kidney Stones

Physical Activity in the Prevention and Amelioration of Osteoporosis in Women

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