Treatment of Calcium Urolithiasis with Diphosphonate: Efficacy and Hazards

Abstract

The effect of treatment of renal stone formation with 5 to 20 mg./kg. per day oral disodium ethane-1-hydroxy-1,1-diphosphonate for up to 30 months was examined in 12 patients with active renal (calcium) stone disease. The over-all incidence of stone passage decreased from 17.8 stones per year per patient before treatment to 7.7 stones per year per patient during therapy. Of the 12 patients 7 passed fewer stones or no stones during treatment. However, the incidence of stone passage was not changed substantially by disodium ethane-1-hydroxy-1,1-diphosphonate in 5 patients. Symptoms of muscle weakness and pain in the back, hips and shoulders occurred in 3 patients during treatment, 2 patients had an increase in serum alkaline phosphatase and 1 patient had a decrease in bone density. Although disodium ethane-1-hydroxy-1,1-diphosphonate may be clinically useful to manage calcium urolithasis in certain patients its over-all use is limited because of its ineffectiveness in some patients and owing to its potential to induce osteomalacia.

Effect of Etidronate Treatment on Bone Mass of Male Nephrolithiasis Patients with Idiopathic Hypercalciuria and Osteopenia

“…However, the long half-life in bone [51] and the undesired effect on mineralization prevented us to do so. In addition, attempts to reduce crystal growth in calcium nephrolithiasis patients by high doses of etidronate have failed to demonstrate a significant reduction in urinary calcium as well [52, 53, 54]. Oral calcium supplementation is included in many of these studies as part of the therapeutic regimen, but none of them mentions the period in which urinary calcium was determined in relation to the cyclic administration of etidronate [46, 47, 48, 49, 50].…”

Inhibition of Nanobacteria by Antimicrobial Drugs as Measured by a Modified Microdilution Method

“…The stimuli for calcium salt deposition in patients with these conditions are unclear, but nidi for precipitation and crystallization are needed even under supersaturation conditions (9). In this regard, antibiotics (27,70,74), bisphosphonates (5,8,20,28,(38)(39)(40)60), citrate (12), and other chemotherapeutics (5, 37) have been used with some success for the treatment of pathological calcification-related diseases. The inhibitory effects of antibiotics on the calcifications of surgically implanted artificial materials have also been shown (11).…”

Recurrent vesical calculi, hypercalciuria and biochemical evidence of increased bone resorption in an adult male with paraplegia due to spinal cord injury: is there a role for intermittent oral disodium etidronate therapy for prevention of calcium phosphate bladder stones?

“…In the past, etidronate therapy for urolithiasis led to side effects 5,6 probably because etidronate was administered continuously or, phosphate was also prescribed. Hopefully, side effects such as osteomalacia may not occur with intermittent etidronate therapy, which is represented by 3-4 months of continuous therapy, followed by 2 weeks of etidronate and 12 weeks without.…”

“…Early attempts to treat calcium urolithiasis, retarding the crystal growth of urinary brushite with bisphosphonates have been reported in the literature, 5,13 but it seems that the potential bone hazards have overcome their efficacy on stone formation. Surprisingly, there were no significant changes in urinary calcium in the latter cited study.…”