Determinants of Osteopenia in Male Renal-Stone–Disease Patients with Idiopathic Hypercalciuria

Clinical journal of the American Society of Nephrology : CJASN - Tập 6 Số 5 - Trang 1149-1154 - 2011
Emmanuel Letavernier1,2,3, Olivier Traxer1,3, Michel Daudon4, M. Tligui1, Jérôme Hubert-Brierre1, Dominique Guerrot2,3, A Sebag5, Laurent Baud1,2,3, Jean‐Philippe Haymann1,2,3
1Assistance publique-Hôpitaux de Paris, Hôpital Tenon, F-75020, Paris, France
2INSERM, UMR S 702, F-75020, Paris, France
3Université Pierre et Marie Curie, Paris 06, UMR S 702, F-75020, Paris, France
4Assistance publique-Hôpitaux de Paris, Hôpital Necker, F-75015, Paris, France
5Assistance publique-Hôpitaux de Paris, Hôpital Rothschild, F-75012, Paris, France

Tóm tắt

Summary Background and objectives

Bone demineralization is frequent in renal-stone formers with hypercalciuria. Although this pathologic link has been recognized for decades, the underlying mechanisms and risk factors associated with osteopenia/osteoporosis in this population remain partially understood.

 Design, setting, participants, & measurements

This study retrospectively analyzed determinants of low bone mineral density (BMD) in 65 idiopathic hypercalciuric male renal-stone formers. Clinical and biologic evaluation included BMD measurement, bone-remodeling markers, analysis of calcium metabolism with oral calcium load test, and dietary inquiry.

 Results

Patients with osteopenia (n = 23, 35% of the population) presented significantly higher fasting calciuria as compared with normal bone density patients (n = 42) (calcium/creatinine ratio was 0.32 versus 0.24 mmol/mmol; P = 0.006). Analysis of the whole population revealed a negative association between fasting hypercalciuria and BMD (P = 0.003), independent of confounding variables including body-mass index and tobacco consumption. The fasting calcium/creatinine ratio above 0.25 mmol/mmol was associated with a 3.8-fold increase in the risk of low BMD.

 Conclusion

In our study, fasting hypercalciuria after a 2-day calcium-restricted diet appears as the only biologic factor associated with low BMD, suggesting a bone-calcium efflux. Our results support the view of a parathyroid-independent pathologic process that remains to be identified. Hypercalciuric patients with low BMD do not excrete more calcium in 24-hour urine samples than patients without low BMD.

Từ khóa


Tài liệu tham khảo

Alhava, 1976, Bone mineral density in patients with urolithiasis: A preliminary report, Scand J Urol Nephrol, 10, 154, 10.3109/00365597609179678

Melton, 1998, Fracture risk among patients with urolithiasis: A population-based cohort study, Kidney Int, 53, 459, 10.1046/j.1523-1755.1998.00779.x

Lauderdale, 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, 10.1359/jbmr.2001.16.10.1893

Bataille, 1991, Diet, vitamin D and vertebral mineral density in hypercalciuric calcium stone formers, Kidney Int, 39, 1193, 10.1038/ki.1991.151

Zerwekh, 2008, Bone disease and idiopathic hypercalciuria, Semin Nephrol, 28, 133, 10.1016/j.semnephrol.2008.01.006

Daudon, 2005, [Epidemiology of nephrolithiasis in France], Ann Urol, 39, 209, 10.1016/j.anuro.2005.09.007

Zilberman, 2010, The impact of societal changes on patterns of urolithiasis, Curr Opin Urol, 20, 148, 10.1097/MOU.0b013e3283353b6d

Bijvoet, 1970, Plasma-phosphate and tubular reabsorption of phosphate, Lancet, 760, 1345, 10.1016/S0140-6736(70)91945-8

Pak, 1975, A simple test for the diagnosis of absorptive, resorptive and renal hypercalciurias, N Engl J Med, 292, 497, 10.1056/NEJM197503062921002

Anderson, 1961, Renal calcification, calculus formation, and the urinary excretion of calcium, Lancet, 2, 454, 10.1016/S0140-6736(61)92429-1

Taylor, 2009, Demographic, dietary, and urinary factors and 24-h urinary calcium excretion, Clin J Am Soc Nephrol, 4, 1980, 10.2215/CJN.02620409

Vezzoli, 2005, Urinary calcium is a determinant of bone mineral density in elderly men participating in the InCHIANTI study, Kidney Int, 67, 2006, 10.1111/j.1523-1755.2005.00302.x

Heilberg, 2006, Bone disease in idiopathic hypercalciuria, Curr Opin Nephrol Hypertens, 15, 394, 10.1097/01.mnh.0000232880.58340.0c

Tasca, 2002, Bone alterations in patients with idiopathic hypercalciuria and calcium nephrolithiasis, Urology, 59, 865, 10.1016/S0090-4295(02)01626-6

Asplin, 2003, Bone mineral density and urine calcium excretion among subjects with and without nephrolithiasis, Kidney Int, 63, 662, 10.1046/j.1523-1755.2003.00763.x

Vezzoli, 2003, Intestinal calcium absorption is associated with bone mass in stone-forming women with idiopathic hypercalciuria, Am J Kidney Dis, 42, 1177, 10.1053/j.ajkd.2003.08.018

Reid, 2008, Relationships between fat and bone, Osteoporos Int, 19, 595, 10.1007/s00198-007-0492-z

Broadus, 1984, Evidence for disordered control of 1,25-dihydroxyvitamin D production in absorptive hypercalciuria, N Engl J Med, 311, 73, 10.1056/NEJM198407123110201

Krieger, 1996, Increased sensitivity to 1,25(OH)2D3 in bone from genetic hypercalciuric rats, Am J Physiol, 271, C130, 10.1152/ajpcell.1996.271.1.C130

Pasch, 2008, PTH and 1.25 vitamin D response to a low-calcium diet is associated with bone mineral density in renal stone formers, Nephrol Dial Transplant, 23, 2563, 10.1093/ndt/gfn091

Heller, 2007, Reduced bone formation and relatively increased bone resorption in absorptive hypercalciuria, Kidney Int, 71, 808, 10.1038/sj.ki.5002181

Gomes, 2008, RANKL is a mediator of bone resorption in idiopathic hypercalciuria, Clin J Am Soc Nephrol, 3, 1446, 10.2215/CJN.00240108

Coe, 1982, Effects of low-calcium diet on urine calcium excretion, parathyroid function and serum 1,25(OH)2D3 levels in patients with idiopathic hypercalciuria andin normal subjects, Am J Med, 72, 25, 10.1016/0002-9343(82)90567-8

Asplin, 2006, Urine calcium excretion predicts bone loss in idiopathic hypercalciuria, Kidney Int, 70, 1463, 10.1038/sj.ki.5001778

Thông tin
Thông tin xuất bản

Clinical journal of the American Society of Nephrology : CJASN

Tập 6 Số 5

1149-1154

Thông tin tác giả