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Abdalbary M, Chishti E, Shakhashiro M, Mohamed R, Parikh T, Nassar MK, Sayed-Ahmed N, Faugere MC, Sawaya BP, El-Husseini A. Impact of urinary calcium excretion on kidney, bone, and cardiovascular systems in patients with bone biopsy proven osteoporosis: a longitudinal long-term follow-up study. Osteoporos Int 2023; 34:763-774. [PMID: 36790470 DOI: 10.1007/s00198-023-06686-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Abstract
UNLABELLED The impact of urine calcium on kidney, bone, and cardiovascular systems in osteoporosis is not well-known. In this 7-year-follow-up study, high urine calcium did not affect kidney function but increased risk of kidney stones, while low urine calcium increased cardiovascular diseases. Maintaining normal urine calcium is beneficial for bone health. PURPOSE Hypercalciuria is common in patients with osteoporosis. However, the long-term effect of urinary calcium excretion (UCaE) on patients' health is not well-examined. The current study aims to assess the impact of UCaE on kidney, bone, and cardiovascular outcomes in patients with bone biopsy proven osteoporosis. METHODS Longitudinal study of all patients with osteoporosis who underwent bone biopsy and 24-h urine collection between 2008 and 2015 in the University of Kentucky. DXA scans, serum markers, kidney function, and cardiovascular events were recorded until last clinic visit in 2021. Exclusion criteria were secondary osteoporosis or conditions that might substantially impact UCaE. The significant results in univariate analysis were confirmed in multi-variable regression models involving clinically important covariates that might impact patients' outcomes. RESULTS Study included 230 patients with mean follow-up of 7.2 ± 2.9 years. The mean age was 61 years, and the mean eGFR at baseline was 85 ± 19 ml/min/1.73 m2. Low bone turnover (LBT) was present in 57% and high bone turnover (HBT) in 43% of patients. Hypercalciuria was found in one-third of patients with no difference between LTB and HTB. UCaE correlated positively with eGFR but did not affect the rate of eGFR decline over time. Higher UCaE predicted kidney stones development. We observed U-shaped effect of UCaE on bone health. Hypercalciuria predicted loss of BMD at all sites, but also hypocalciuria was associated with higher loss in total hip BMD. Upper limb fractures were the most observed fractures, and their incidence was higher in patients with hyper- or hypo-calciuria. Lower UCaE independently predicted development of major adverse cardiac events (MACE) and cardiovascular disease (CVD). CONCLUSION UCaE correlated with eGFR but it did not affect the change of eGFR over time. Patients with normal UCaE had lower incidence of upper limb fractures and less reduction in BMD. Low UCaE predicted MACE and CVD.
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Affiliation(s)
- M Abdalbary
- Mansoura Nephrology and Dialysis Unit, Mansoura University, 1 El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt.
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, USA.
| | - E Chishti
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, USA
| | - M Shakhashiro
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, USA
| | - R Mohamed
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, USA
| | - T Parikh
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, USA
| | - M K Nassar
- Mansoura Nephrology and Dialysis Unit, Mansoura University, 1 El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
| | - N Sayed-Ahmed
- Mansoura Nephrology and Dialysis Unit, Mansoura University, 1 El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
| | - M-C Faugere
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, USA
| | - B P Sawaya
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, USA
| | - A El-Husseini
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, USA
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Shih HY, Lu JH, Xiong AH, Tse JMW, Wong BST. Topical application of the plant extract SDTL-E in ovariectomized rats: A potential new approach for treating osteoporosis. Front Med (Lausanne) 2022; 9:988235. [PMID: 36341259 PMCID: PMC9631791 DOI: 10.3389/fmed.2022.988235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/06/2022] [Indexed: 07/16/2024] Open
Abstract
Current osteoporosis medications have drawbacks of causing side effects and having slow onset, therefore developing osteoporosis drugs with faster onset and less side effects is essential. This study investigated the effects of the natural plant extract, SDTL-E, in ovariectomized (OVX)-induced osteoporosis rats. Rats were randomly assigned to sham operation control group (Control Group); OVX rat model group (Model Group) or OVX rat SDTL-E treatment group (SDTL-E Group). All groups underwent ovariectomy, but the Control Group did not have the ovaries removed. SDTL-E Group was treated with SDTL-E, Model and Control Groups were treated with vegetable oil, treatments were topically applied twice daily for 20 days. Results showed when compared with Model Group, SDTL-E Group significantly restored serum estradiol back to near Control Group level, serum ALP activity, serum and urinary calcium were significantly decreased, bone mechanics indicators increased and trabecular bone numbers slightly increased. These results demonstrated 20 days of SDTL-E topical treatment improved bone strength and trabecular bone structure in OVX-induced osteoporosis rats. The underlying mechanisms include restoring estradiol level, reducing bone turnover, net bone resorption, bone calcium loss, and calcium excretion through kidney. These findings suggest topical application of plant extract is a potential new approach with quick efficacy for treating osteoporosis.
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Affiliation(s)
- Hui-Yuan Shih
- Hong Kong Small Biomolecules Laboratory, Hong Kong, Hong Kong SAR, China
| | - Jun-Hua Lu
- Department of Pharmacology, Jinan University College of Pharmacy, Guangzhou, China
| | - Ai-Hua Xiong
- Laboratory Technical Teaching Centre, Jinan University College of Pharmacy, Guangzhou, Hong Kong SAR, China
| | | | - Ben Siu-Tak Wong
- SDTL Reborntech Company Limited, Hong Kong, Hong Kong SAR, China
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3
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Ebeling PR, Nguyen HH, Aleksova J, Vincent AJ, Wong P, Milat F. Secondary Osteoporosis. Endocr Rev 2022; 43:240-313. [PMID: 34476488 DOI: 10.1210/endrev/bnab028] [Citation(s) in RCA: 100] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 02/07/2023]
Abstract
Osteoporosis is a global public health problem, with fractures contributing to significant morbidity and mortality. Although postmenopausal osteoporosis is most common, up to 30% of postmenopausal women, > 50% of premenopausal women, and between 50% and 80% of men have secondary osteoporosis. Exclusion of secondary causes is important, as treatment of such patients often commences by treating the underlying condition. These are varied but often neglected, ranging from endocrine to chronic inflammatory and genetic conditions. General screening is recommended for all patients with osteoporosis, with advanced investigations reserved for premenopausal women and men aged < 50 years, for older patients in whom classical risk factors for osteoporosis are absent, and for all patients with the lowest bone mass (Z-score ≤ -2). The response of secondary osteoporosis to conventional anti-osteoporosis therapy may be inadequate if the underlying condition is unrecognized and untreated. Bone densitometry, using dual-energy x-ray absorptiometry, may underestimate fracture risk in some chronic diseases, including glucocorticoid-induced osteoporosis, type 2 diabetes, and obesity, and may overestimate fracture risk in others (eg, Turner syndrome). FRAX and trabecular bone score may provide additional information regarding fracture risk in secondary osteoporosis, but their use is limited to adults aged ≥ 40 years and ≥ 50 years, respectively. In addition, FRAX requires adjustment in some chronic conditions, such as glucocorticoid use, type 2 diabetes, and HIV. In most conditions, evidence for antiresorptive or anabolic therapy is limited to increases in bone mass. Current osteoporosis management guidelines also neglect secondary osteoporosis and these existing evidence gaps are discussed.
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Affiliation(s)
- Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia
| | - Hanh H Nguyen
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Department of Endocrinology and Diabetes, Western Health, Victoria 3011, Australia
| | - Jasna Aleksova
- Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Amanda J Vincent
- Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria 3168, Australia
| | - Phillip Wong
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Frances Milat
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
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4
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Urine and Serum Electrolytes and Biochemical Values Associated with Osteoporosis in Premenopausal and Postmenopausal Women: A Longitudinal and Cross-Sectional Study Using Korean Genome and Epidemiology Study (KoGES) Cohort. J Clin Med 2021; 10:jcm10102155. [PMID: 34067578 PMCID: PMC8156403 DOI: 10.3390/jcm10102155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis is a major public health concern, especially in women. This study aims to identify early biomarkers from biochemical measurements of serum and urine for recognizing the development of osteoporosis and osteopenia in premenopausal and postmenopausal women. From the Korean Genome and Epidemiology Study (KoGES) cohort, longitudinal study participants with normal bone density were enrolled and assessed for the association of baseline clinical and biochemical factors with osteoporosis development over 4 years. In addition, a cross-sectional study between normal bone density and osteopenia/osteoporosis was conducted to validate the risk factors found in the longitudinal cohort. Of the 5272 female participants in the KoGES cohort, 813 women (501 premenopausal and 312 menopausal) who had normal bone density at baseline were included in the longitudinal study. During the 4 years of follow-up, 64 patients developed osteoporosis and 354 developed osteopenia. In a multivariate logistic regression analysis, serum calcium and urine uric acid levels were significantly associated with elevated osteoporosis risk in premenopausal and postmenopausal women, respectively (risk of osteoporosis by serum calcium levels in premenopausal women: 4.03 (1.09–14.93), p = 0.037; risk of osteoporosis by urine uric acid levels in postmenopausal women: 24.08 (1.79–323.69), p = 0.016). For the cross-sectional study, serum and urine parameters were compared between women with osteopenia or osteoporosis at baseline and those with normal bone density. Urine uric acid levels were found to be significantly higher in both premenopausal and postmenopausal women with bone loss than in women with normal bone density (p < 0.001 and p = 0.004, respectively). Uric acid level in urine may be an early marker for the development of osteoporosis in women, especially after menopause.
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Xie L, Hu X, Li W, Ouyang Z. A retrospective study of end-stage kidney disease patients on maintenance hemodialysis with renal osteodystrophy-associated fragility fractures. BMC Nephrol 2021; 22:23. [PMID: 33430788 PMCID: PMC7802139 DOI: 10.1186/s12882-020-02224-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/23/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nephropathy associated metabolic disorder induces high incidence of fragility fracture in end-stage renal disease (ESRD) patients. As the risk factors and prognosis of fragility fracture in ESRD patients are unclear, more research is needed. This study aimed to evaluate various risk factors for ESRD-related fragility fractures, explore factors affecting the prognosis of patients with such fractures, and provide information for prevention and treatment of renal osteopathy to improve the prognosis of patients. METHODS In this retrospective case-control study, the case notes of 521 ESRD patients who received maintenance dialysis for at least 3 months were examined. Finally, 44 patients diagnosed with fragility fractures were assigned to the fragility fracture (FF) group and 192 patients were included in the control group (CG). Demographic information, underlying diseases, nutritional, bone metabolism, and renal function parameters, along with the number and causes of any deaths, were recorded for multiple statistical analysis. RESULTS The FF group had increased incidences of essential hypertension and diabetes mellitus and higher serum calcium, corrected calcium, alkaline phosphatase, and hemoglobin levels. Immunoreactive parathyroid hormone (iPTH), total cholesterol (TC), and low density lipoprotein (LDL) levels were higher in the CG. Multivariate Cox regression analysis revealed that fragility fracture was an independent risk factor for all-cause mortality in ESRD patients (P < .001, RR: 4.877, 95% CI: 2.367-10.013). CONCLUSIONS Essential hypertension and diabetes, high serum calcium and alkaline phosphatase levels, and reduced iPTH levels were risk factors for fragility fracture in ESRD patients. Maintaining iPTH and serum TC levels may protect against fragility fractures in them. Fragility fractures may yield poor prognosis and shorter lifespan. The presence of fragility fracture was an independent predictor of all-cause death in ESRD patients.
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Affiliation(s)
- Lihua Xie
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, P.R. China
| | - Xuantao Hu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, P.R. China
| | - Wenzhao Li
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, P.R. China.
| | - Zhengxiao Ouyang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, P.R. China.
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Liu B, Liu C, Zhong W, Song M, Du S, Su J. Reduced hepcidin level features osteoporosis. Exp Ther Med 2018; 16:1963-1967. [PMID: 30186425 PMCID: PMC6122228 DOI: 10.3892/etm.2018.6410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/15/2018] [Indexed: 01/01/2023] Open
Abstract
Osteoporosis (OP) is a common serious skeletal disorder marked by increased risk of bone fracture due to fragility. OP has been taken to be a disease linked with abnormal calcium metabolism that alone is obviously insufficient to explain the development of OP. Iron overload has been associated with the development of OP and increasing studies have suggested the association. However, direct evidence for this has not been clinically established. To this end, using the Roche biochemical autoanalyzer, we detected the concentration of iron, soluble transferrin receptor 2 (TFR2), and hepcidin, a key peptide regulating iron homeostasis, in the sera from patients with OP. It was shown that the iron and TFR2 concentration was markedly higher than that of healthy control; whereas the concentration of hepcidin was markedly lower than that in control. In addition, to pilot explore the underlying mechanism by which hepcidin was downregulated, we present that hepcidin can directly interact with TFR2 using immunoprecipitation. The present study first established the direct biochemical evidence for the involvement of hepcidin in the pathogenesis of OP, indicating that the upregulation of hepcidin could be used as a novel alternative therapeutic strategy in the management of OP.
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Affiliation(s)
- Bin Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Caihua Liu
- Department of Laboratory Medicine, People's Hospital of Qingdao Shibei District, Qingdao, Shandong 266033, P.R. China
| | - Weifeng Zhong
- Department of Hospital Infection Management, People's Hospital of Zhangqiu District, Jinan, Shandong 250200, P.R. China
| | - Min Song
- Department of Dermatoloogy, People's Hospital of Zhangqiu District, Jinan, Shandong 250200, P.R. China
| | - Shouqin Du
- Department of Laboratory Medicine, People's Hospital of Zhangqiu District, Jinan, Shandong 250200, P.R. China
| | - Jianli Su
- Department of Laboratory Medicine, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong 266035, P.R. China
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Wang J, Zheng X, Zhang L, Zhang Y, Xiong J, Cheng Y, Shi H, Qiu X, Zhou L, Sun X. The variation in urinary calcium levels in adult patients with fracture and surgical intervention. J Orthop Surg Res 2017; 12:123. [PMID: 28810891 PMCID: PMC5558773 DOI: 10.1186/s13018-017-0624-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/25/2017] [Indexed: 12/15/2022] Open
Abstract
Background Generally, a higher calcium diet is fed to fracture patients after surgery. However, recent studies have indicated that higher dietary calcium intakes increase the risk of urinary stones for fracture patients. Therefore, this study aimed to observe the variation in urinary calcium levels among fracture patients who underwent surgery, based on fracture type, fracture location, age and gender. Methods A total of 768 subjects were enrolled in this study from 2012 to 2015 and were divided into 2 groups: group A (fracture patients who underwent surgery) and group B (normal patients without fracture). Urine samples were collected for a 24-h period (24-h urine), at multiple specific time points before and after surgery for group A, or after hospitalisation for group B. Subsequently, urine calcium was detected and the changes were evaluated according to fracture location, fracture type, age and gender, as well as the distribution of hypercalciuria. Results Compared with group B, the level of urine calcium in group A significantly increased at different time points during the study period (P < 0.05). There were significant differences in the changes in urine calcium levels according to fracture location, fracture type and age, but not gender. Further, there were more patients with hypercalciuria in group A at the different time points, compared with group B. Conclusion Variation in urinary calcium among fracture patients that underwent surgery was of a regular pattern and hypercalciuria was also found in these patients. Therefore, a high-calcium diet and calcium supplements should be used with caution in this patient population.
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Affiliation(s)
- Junfei Wang
- Department of Orthopedics, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China
| | - Xin Zheng
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, China
| | - Liming Zhang
- Department of Urology, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Yifan Zhang
- Department of Urology, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Jin Xiong
- Department of Orthopedics, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China
| | - Yixin Cheng
- Department of Orthopedics, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China
| | - Hongfei Shi
- Department of Orthopedics, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China
| | - Xusheng Qiu
- Department of Orthopedics, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China
| | - Leqin Zhou
- Department of Urology, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Xizhao Sun
- Department of Orthopedics, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China. .,Department of Urology, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, Nanjing, 210008, China.
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Girón-Prieto MS, Arias-Santiago S, Del Carmen Cano-García M, Poyatos-Andújar A, de Haro-Muñoz T, Abad-Menor F, Quesada-Charneco M, Arrabal-Polo MÁ, Arrabal-Martín M. Bone remodeling markers as lithogenic risk factors in patients with osteopenia-osteoporosis. Int Urol Nephrol 2016; 48:1777-1781. [PMID: 27376897 DOI: 10.1007/s11255-016-1361-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/28/2016] [Indexed: 11/28/2022]
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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Affiliation(s)
- María Sierra Girón-Prieto
- Centro de Salud de Pinos Puente, Programa de Doctorado de Medicina Clínica y Salud Pública, Universidad de Granada, Granada, Spain
| | | | - María Del Carmen Cano-García
- UGC Urologia, Complejo Hospitalario Universitario Granada, Dr Virgili street, 9, bajo C. Huercal Overa, 04600, Granada, Spain.,Instituto IBS Granada, Granada, Spain
| | | | | | - Felix Abad-Menor
- UGC Urologia, Complejo Hospitalario Universitario Granada, Dr Virgili street, 9, bajo C. Huercal Overa, 04600, Granada, Spain.,Instituto IBS Granada, Granada, Spain
| | | | - Miguel Ángel Arrabal-Polo
- UGC Urologia, Complejo Hospitalario Universitario Granada, Dr Virgili street, 9, bajo C. Huercal Overa, 04600, Granada, Spain. .,Instituto IBS Granada, Granada, Spain.
| | - Miguel Arrabal-Martín
- UGC Urologia, Complejo Hospitalario Universitario Granada, Dr Virgili street, 9, bajo C. Huercal Overa, 04600, Granada, Spain.,Instituto IBS Granada, Granada, Spain
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