Abstract
Purpose
To analyze the presence of phosphocalcic metabolism disorders in patients with osteopenia–osteoporosis without nephrolithiasis with respect to a control group.
Methods
A cross-sectional study was conducted in patients with osteopenia–osteoporosis without nephrolithiasis (n = 67) in lumbar spine or femur and in a control group (n = 61) with no lithiasis or bone disorders. Blood bone markers, phosphocalcic metabolism, fasting urine, 24-h urine lithogenic risk factors, and densitometry were recorded in both groups. SPSS 20.0 was used for statistical analysis.
Results
In comparison with the controls, significantly higher blood calcium (9.27 ± 0.36 vs. 9.57 ± 0.38, p = 0.0001), intact parathormone (45.6 ± 14.9 vs. 53.8 ± 18.9, p = 0.008), and alkaline phosphatase (61.9 ± 20.9 vs. 70.74 ± 18.9, p = 0.014) levels were found in patients with osteopenia–osteoporosis. In the 24-h urine test, citrate (1010.7 ± 647.8 vs. 617.6 ± 315.8, p = 0.0001) and oxalate (28.21 ± 17.65 vs. 22.11 ± 16.49, p = 0.045) levels were significantly lower in osteopenia–osteoporosis patients than in controls, with no significant difference in calcium (187.3 ± 106.9 vs. 207.06 ± 98.12, p = 0.27) or uric acid (540.7 ± 186.2 vs. 511.9 ± 167.06, p = 0.35) levels. Patients with osteopenia–osteoporosis had significantly higher levels of lithogenic risk factors associated with bone remodeling, including significantly increased β-crosslaps and osteocalcin values and higher β-crosslaps/osteocalcin ratios.
Conclusion
Patients with osteopenia–osteoporosis without nephrolithiasis showed phosphocalcic metabolism disorders as well as lower urinary citrate and higher β-crosslaps/osteocalcin and fasting calcium/creatinine ratios, which would increase the risk of nephrolithiasis. Hence, prospective studies are warranted to evaluate the long-term risks.
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References
Sakhaee K, Maalouf NM, Kumar R, Pasch A, Moe OW (2011) Nephrolithiasis-associated bone disease: pathogenesis and treatment options. Kidney Int 79:393–403
Caudarella R, Vescini F, Buffa A, Sinicropi G, Rizzoli E, La Manna G et al (2003) Bone mass loss in calcium stone disease: focus on hypercalciuria and metabolic factors. J Nephrol 16:260–266
Lauderdale DS, Thisted RA, Wen M, Favus MJ (2001) Bone mineral density and fracture among prevalent kidney stone cases in the third national health and nutrition examination survey. J Bone Miner Res 16:1893–1898
Keller JJ, Lin CC, Kang JH, Lin HC (2013) Association between osteoporosis and urinary calculus: evidence from a population-based study. Osteoporos Int 24:651–657
Heilberg IP, Weisinger JR (2006) Bone disease in idiopathic hypercalciuria. Curr Opin Nephrol Hypertens 15:394–402
Tasca A, Cacciola A, Ferrarese P, Ioverno E, Visonà E, Bernardi C et al (2002) Bone alterations in patients with idiopathic Hypercalciuria and calcium nephrolithiasis. Urology 59:865–869
Arrabal-Polo MÁ, Arrabal-Martín M, Girón-Prieto MS, Orgaz-Molina J, Quesada-Charneco M, López-Ruiz A et al (2003) Association of severe calcium lithogenic activity and bone remodeling markers. Urology 82:16–21
Delmas PD, Eastell R, Garnero P, Seibel MJ, Stepan J (2000) Committee of Scientific advisors of the International Osteoporosis Foundation. The use of biochemical markers of bone turnover in osteoporosis. Osteoporos Int 11(suppl 6):2–17
Garnero P (2008) New biochemical markers of bone turnover. IBMS Bonekey 5:84–102
Arrabal-Polo MA, Arrabal-Martin M, Poyatos-Andujar A, Cardenas-Grande E, Merino-Salas S, Zuluaga-Gomez A (2012) Is the fasting calcium/creatinine a bone resorption marker in patients with calcium renal stones? Urol Res 40:243–245
Chou PS, Kuo CN, Hung KS, Chang WC, Liao YC, Chi YC et al (2014) Osteoporosis and the risk of symptomatic nephrolithiasis: a population-based 5-year follow-up study in Taiwan. Calcif Tissue Int 95:317–322
Asplin JR, Bauer KA, Kinder J, Müller G, Coe BJ, Parks JH et al (2003) Bone mineral density and urine calcium excretion among subjects with and without nephrolithiasis. Kidney Int 63:662–669
Tsuji H, Umekawa T, Kurita T, Uemura H, Iguchi M, Kin K et al (2005) Analysis of bone mineral density in urolithiasis patients. Int J Urol 12:335–339
Ryan LE, Ing SW (2012) Idiopathic hypercalciuria and bone health. Curr Osteoporos Rep 10:286–295
Rull MA, Cano-García Mdel C, Arrabal-Martín M, Arrabal-Polo MA (2015) The importance of urinary calcium in postmenopausal women with osteoporotic fracture. Can Urol Assoc J 9:E183–E186
O’Neill S, MacLennan A, Bass S, Diamond T, Ebeling P, Findlay D et al (2004) Guidelines for the management of postmenopausal osteoporosis for GPs. Aust Fam Physician 33:910–919
Krieger NS, Bushinsky DA (2013) The relation between bone and stone formation. Calcif Tissue Int 93:374–381
Bilic-Curcic I, Milas-Ahic J, Smolic M, Smolić R, Mihaljević I, Tucak-Zorić S (2009) Urolithiasis and osteoporosis: clinical relevance and therapeutic implications. Coll Antropol 33(Suppl. 2):189–192
Caudarella R, Vescini F, Buffa A, La Manna G, Stefoni S (2004) Osteoporosis and urolithiasis. Urol Int 72(suppl 1):17–19
Arrabal Polo MA, Arrabal Martin M, Arias Santiago S, Garrido-Gomez J, Poyatos-Andujar A, Zuluaga-Gomez A (2013) Importance of citrate and the calcium: citrate ratio in patients with calcium renal lithiasis and severe lithogenesis. BJU Int 111:622–627
Acknowledgments
This article is a part of doctoral thesis of Maria Sierra Girón-Prieto. Doctorado Medicina Clinica y Salud Publica. This investigation has been founded by Fundacion Progreso y Salud. Consejeria de Salud. Junta de Andalucia. Pi 0766/2013.
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It is a low ethically responsible study in which the patients gave their informed consent after reading the Patient Information Sheet. The study was approved by the Hospital Ethics Committee.
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Girón-Prieto, M.S., Arias-Santiago, S., del Carmen Cano-García, M. et al. Bone remodeling markers as lithogenic risk factors in patients with osteopenia–osteoporosis. Int Urol Nephrol 48, 1777–1781 (2016). https://doi.org/10.1007/s11255-016-1361-5
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DOI: https://doi.org/10.1007/s11255-016-1361-5