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Adjustment for body mass index and calcitrophic hormone levels improves the diagnostic accuracy of the spot urine calcium-to-creatinine ratio

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Abstract

Summary

Providers diagnose hypercalciuria using a 24-hour or random urine samples. We compared calcium measurements from paired 24-hour and morning urine samples; measurements correlated poorly. We developed a formula to correct random urine calcium levels. Corrected levels showed excellent agreement with 24-hour measurements. Until validation, providers should diagnose hypercalciuria using 24-hour tests.

Introduction

Hypercalciuria is a risk factor for osteoporosis and nephrolithiasis. The 24-hour urine calcium (24HUC) measurement is the gold standard to diagnose hypercalciuria, but the spot urine calcium-to-creatinine ratio (SUCCR) is more convenient. Although authors claim they are interchangeable, we observed inconsistencies during the conduct of a clinical trial. Therefore, we systematically evaluated agreement between the tests.

Methods

During a 28-inpatient calcium absorption studies in 16 postmenopausal women, we simultaneously collected paired fasting morning and 24-hour urine specimens.

Results

We found moderate correlation between paired SUCCR and 24HUC specimens (r = 0.57, p = 0.002), but the SUCCR underestimated 24HUC by a mean of 83 mg (Bland–Altman). We diagnosed hypercalciuria (24HUC >250 mg) in eight specimens using the 24HUC, but only in two specimens using the SUCCR (25% sensitivity). We developed a regression model to predict 24HUC using SUCCR, parathyroid hormone, body mass index, and 1,25(OH)2D. The model improved diagnostic sensitivity to 100% and decreased Bland–Altman bias of the SUCCR to +0.06 mg/kg/24-hour.

Conclusions

We conclude that the SUCCR underestimates urine calcium loss and does not reliably diagnose hypercalciuria. A formula derived from multivariate regression incorporating other readily measurable variables greatly improved the SUCCR’s accuracy. Future studies must verify this correction before clinical implementation.

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Acknowledgment

We thank Dr. Don Schalch for his advice and guidance during the preparation of this manuscript.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA

    A. N. Jones, R. D. Blank & K. E. Hansen

  2. University of Wisconsin Osteoporosis Clinical Center and Research Program, 2870 University Avenue Suite 100, Madison, WI, 53705, USA

    A. N. Jones, R. D. Blank & K. E. Hansen

  3. William S. Middleton Veterans Affairs Medical Center GRECC Service, 2500 Overlook Terrace, Madison, WI, 53705, USA

    R. D. Blank

  4. University of Wisconsin Department of Biostatistics and Medical Informatics, 600 Highland Avenue, Madison, WI, 53792, USA

    M. J. Lindstrom

  5. Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA

    K. L. Penniston

  6. University of Wisconsin School of Medicine and Public Health, Mailbox 3244, Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA

    K. E. Hansen

Authors
  1. A. N. Jones
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  2. R. D. Blank
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  3. M. J. Lindstrom
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  4. K. L. Penniston
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  5. K. E. Hansen
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Corresponding author

Correspondence to K. E. Hansen.

Additional information

Grant support from Jackson Foundation, NIH (K23 AR050995), GCRC (NCRR M01 RR03186), a Junior Career Development Award in Geriatric Medicine (T. Franklin Williams Scholar Award, Atlantic Philanthropies, American College of Rheumatology Research and Education Foundation), and a New Investigator Grant from the Medical Education and Research Committee of the Wisconsin Partnership Program. This paper is based on work conducted in part in the William S. Middleton Veterans’ Hospitals’ Geriatrics, Research, Education, and Clinical Center and is GRECC manuscript #2009-10.

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Jones, A.N., Blank, R.D., Lindstrom, M.J. et al. Adjustment for body mass index and calcitrophic hormone levels improves the diagnostic accuracy of the spot urine calcium-to-creatinine ratio. Osteoporos Int 21, 1417–1425 (2010). https://doi.org/10.1007/s00198-009-1058-z

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  • DOI: https://doi.org/10.1007/s00198-009-1058-z

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