Skip to main content
SpringerLink
Log in

Comparison of the bone mineral density status of patients with kidney stones stratified by stone composition

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

Bone loss has been found to occur frequently in patients with particular metabolic disorders that are likely associated with certain kidney stone composition. Thus, we compared the bone mineral density (BMD) of patients with different kidney stone compositions.

Patients and methods

A total of 204 consecutive patients who exhibited stone formation with calcium oxalate (CaOx), calcium phosphate (CaP), uric acid (UA), and magnesium ammonium phosphate (MAP) underwent 24 h urine test and BMD measurement. BMD was measured by dual X-ray absorptiometry at the lumbar spine (LS) and femoral neck (FN). The Z-score was used to express BMD. A BMD Z-score ≤  − 2 was defined as a diagnostic threshold for bone loss.

Results

Amongst the patients, 38 had an LS BMD Z-score of ≤  − 2, but only 2 had FN BMD Z-score of ≤  − 2. The group with an LS BMD Z-score of ≤  − 2 exhibited significantly larger male − female ratio, higher frequency of hypercalciuria and CaP, and lower frequency of MAP than the group with an LS BMD Z-score of >  − 2. Reduced LS BMD was most remarkable in the CaP group, followed by the CaOx, UA, and MAP groups. The LS BMD Z-score of hypercalciuric patients was significantly lower than that of normocalciuric patients only in the CaP group.

Conclusion

Patients with different kidney stone compositions presented different BMD status. Using this information may facilitate medical decision-making in patients with kidney stone who should undergone BMD earlier.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

All relevant data are within the paper.

References

  1. Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y (2017) Epidemiology of stone disease across the world. World J Urol 35:1301–1320

    Article  PubMed  Google Scholar 

  2. Zeng G, Mai Z, Xia S, Wang Z, Zhang K, Wang L, Long Y, Ma J, Li Y, Wan SP, Wu W, Liu Y, Cui Z, Zhao Z, Qin J, Zeng T, Liu Y, Duan X, Mai X, Yang Z, Kong Z, Zhang T, Cai C, Shao Y, Yue Z, Li S, Ding J, Tang S, Ye Z (2017) Prevalence of kidney stones in China: an ultrasonography based cross-sectional study. BJU Int 120:109–116

    Article  PubMed  Google Scholar 

  3. Alhava EM, Juuti M, Karjalainen P (1976) Bone mineral density in patients with urolithiasis. A preliminary report. Scand J Urol Nephrol 10:154–156

    Article  CAS  PubMed  Google Scholar 

  4. Melton LR, Crowson CS, Khosla S, Wilson DM, O’Fallon WM (1998) Fracture risk among patients with urolithiasis: a population-based cohort study. Kidney Int 53:459–464

    Article  PubMed  Google Scholar 

  5. Lewiecki EM, Gordon CM, Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Silverman S, Bishop NJ, Leonard MB, Bianchi ML, Kalkwarf HJ, Langman CB, Plotkin H, Rauch F, Zemel BS (2008) Special report on the 2007 adult and pediatric position development conferences of the International Society for Clinical Densitometry. Osteoporos Int 19:1369–1378

    Article  CAS  PubMed  Google Scholar 

  6. Sakhaee K, Maalouf NM, Kumar R, Pasch A, Moe OW (2011) Nephrolithiasis-associated bone disease: pathogenesis and treatment options. Kidney Int 79:393–403

    Article  CAS  PubMed  Google Scholar 

  7. Tasca A, Dalle CL, Nigro F, Giannini S (2009) Bone disease in patients with primary hypercalciuria and calcium nephrolithiasis. Urology 74:22–27

    Article  PubMed  Google Scholar 

  8. Wollin DA, Kaplan AG, Preminger GM, Ferraro PM, Nouvenne A, Tasca A, Croppi E, Gambaro G, Heilberg IP (2018) Defining metabolic activity of nephrolithiasis—appropriate evaluation and follow-up of stone formers. Asian J Urol 5:235–242

    Article  PubMed  PubMed Central  Google Scholar 

  9. Domrongkitchaiporn S, Pongsakul C, Stitchantrakul W, Sirikulchayanonta V, Ongphiphadhanakul B, Radinahamed P, Karnsombut P, Kunkitti N, Ruang-raksa C, Rajatanavin R (2001) Bone mineral density and histology in distal renal tubular acidosis. Kidney Int 59:1086–1093

    Article  CAS  PubMed  Google Scholar 

  10. Silva BC, Bilezikian JP (2021) Skeletal abnormalities in hypoparathyroidism and in primary hyperparathyroidism. Rev Endocr Metab Disord 22:789–802

    Article  PubMed  Google Scholar 

  11. Fabris A, Bernich P, Abaterusso C, Marchionna N, Canciani C, Nouvenne A, Zamboni M, Lupo A, Gambaro G (2009) Bone disease in medullary sponge kidney and effect of potassium citrate treatment. Clin J Am Soc Nephrol 4:1974–1979

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Hsi RS, Sanford T, Goldfarb DS, Stoller ML (2017) The role of the 24-hour urine collection in the prevention of kidney stone recurrence. J Urol 197:1084–1089

    Article  PubMed  Google Scholar 

  13. Hesse A, Straub M (2006) Rational evaluation of urinary stone disease. Urol Res 34:126–130

    Article  PubMed  Google Scholar 

  14. Kourambas J, Aslan P, Teh CL, Mathias BJ, Preminger GM (2001) Role of stone analysis in metabolic evaluation and medical treatment of nephrolithiasis. J Endourol 15:181–186

    Article  CAS  PubMed  Google Scholar 

  15. Pak CY, Poindexter JR, Adams-Huet B, Pearle MS (2003) Predictive value of kidney stone composition in the detection of metabolic abnormalities. Am J Med 115:26–32

    Article  CAS  PubMed  Google Scholar 

  16. Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR, Monga M, Penniston K, Preminger GM, Turk TMT, White JR (2014) Medical management of kidney stones: AUA guideline. J Urol 192:316–324

    Article  PubMed  Google Scholar 

  17. Vezzoli G, Rubinacci A, Bianchin C, Arcidiacono T, Giambona S, Mignogna G, Fochesato E, Terranegra A, Cusi D, Soldati L (2003) Intestinal calcium absorption is associated with bone mass in stone-forming women with idiopathic hypercalciuria. Am J Kidney Dis 42:1177–1183

    Article  PubMed  Google Scholar 

  18. Caudarella R, Vescini F, Buffa A, Sinicropi G, Rizzoli E, La Manna G, Stefoni S (2003) Bone mass loss in calcium stone disease: focus on hypercalciuria and metabolic factors. J Nephrol 16:260–266

    CAS  PubMed  Google Scholar 

  19. Elkoushy MA, Jundi M, Lee TT, Andonian S (2014) Bone mineral density status in urolithiasis patients with vitamin D inadequacy followed at a tertiary stone centre. Can Urol Assoc J 8:323–328

    Article  PubMed  PubMed Central  Google Scholar 

  20. Briot K, Cortet B, Tremollieres F, Sutter B, Thomas T, Roux C, Audran M (2009) Male osteoporosis: diagnosis and fracture risk evaluation. Jt Bone Spine 76:129–133

    Article  Google Scholar 

  21. Ferrari S, Bianchi ML, Eisman JA, Foldes AJ, Adami S, Wahl DA, Stepan JJ, de Vernejoul MC, Kaufman JM (2012) Osteoporosis in young adults: pathophysiology, diagnosis, and management. Osteoporos Int 23:2735–2748

    Article  CAS  PubMed  Google Scholar 

  22. McKiernan FE, Berg RL, Linneman JG (2011) The utility of BMD Z-score diagnostic thresholds for secondary causes of osteoporosis. Osteoporos Int 22:1069–1077

    Article  CAS  PubMed  Google Scholar 

  23. Pietschmann F, Breslau NA, Pak CY (1992) Reduced vertebral bone density in hypercalciuric nephrolithiasis. J Bone Miner Res 7:1383–1388

    Article  CAS  PubMed  Google Scholar 

  24. 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

    Article  CAS  PubMed  Google Scholar 

  25. Sakhaee K, Maalouf NM, Poindexter J, Adams-Huet B, Moe OW (2017) Relationship between urinary calcium and bone mineral density in patients with calcium nephrolithiasis. J Urol 197:1472–1477

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Shadman A, Bastani B (2017) Kidney calculi. Pathophysiology and as a systemic disorder. Iran J Kidney Dis 11:180–191

    PubMed  Google Scholar 

  27. Haymann JP (2015) Metabolic disorders stones as first clinical manifestation of significant diseases. World J Urol 33:187–192

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

Supported by Jiangsu Province TCM Hospital Grants k2018ycx51.

Author information

Author notes

  1. Xiaoming Cong, Lili Huang, Xingbo Wang contributed to the work equally and should be regarded as co-first authors.

Authors and Affiliations

  1. Department of Urology, Jiangsu Province Hospital of TCM, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China

    Xiaoming Cong, Xingbo Wang, Liulin Li, Xin Zhang, Xuehua Chen & Yan Xu

  2. Jiangsu Health Development Research Center, NHC Contraceptives Adverse Reaction Surveillance Center, Nanjing, People’s Republic of China

    Lili Huang

Authors
  1. Xiaoming Cong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lili Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xingbo Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Liulin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xuehua Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yan Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

XC contributed to project development, data collection, manuscript writing and revision. LH contributed to data collection, data analysis, and revision. XW contributed to data collection and data analysis. LL contributed to data collection. XZ contributed to data collection. XC contributed to data collection. YX contributed to project development and revision.

Corresponding author

Correspondence to Yan Xu.

Ethics declarations

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

This study was approved by the Ethics Committee at the affiliated Hospital of Nanjing University of Chinese Medicine.

Informed consent

All patients were given a written informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cong, X., Huang, L., Wang, X. et al. Comparison of the bone mineral density status of patients with kidney stones stratified by stone composition. World J Urol 42, 42 (2024). https://doi.org/10.1007/s00345-023-04727-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00345-023-04727-y

Keywords

Search

Navigation