1382 ARE CHILDREN WITH STONES AT RISK FOR BREAKING BONES? BONE MINERAL DENSITY ANALYSIS IN PEDIATRIC STONE FORMERS

Abstract

You have accessJournal of UrologyPediatrics: Stone Disease & Tumors1 Apr 20111382 ARE CHILDREN WITH STONES AT RISK FOR BREAKING BONES? BONE MINERAL DENSITY ANALYSIS IN PEDIATRIC STONE FORMERS Candace Granberg, Katherine Twombley, Aditya Bagrodia, Khashayar Sakhaee, Naim Maalouf, Linda A. Baker, and Nicol C. Bush Candace GranbergCandace Granberg Dallas, TX More articles by this author , Katherine TwombleyKatherine Twombley Dallas, TX More articles by this author , Aditya BagrodiaAditya Bagrodia Dallas, TX More articles by this author , Khashayar SakhaeeKhashayar Sakhaee Dallas, TX More articles by this author , Naim MaaloufNaim Maalouf Dallas, TX More articles by this author , Linda A. BakerLinda A. Baker Dallas, TX More articles by this author , and Nicol C. BushNicol C. Bush Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1227AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Adult stone formers are known to have lower bone mineral density (BMD) and higher rates of osteoporotic fractures compared to non-stone formers. Low BMD in children is associated with increased risk of bone fractures. The objective of this study was to evaluate BMD among our pediatric stone patients. METHODS Retrospective review of all patients undergoing dual-energy x-ray absorptiometry (DXA) scan since 2000 with a confirmed diagnosis of urolithiasis was performed. Immobilized patients were excluded. Z-scores, expressed as number of age- and gender-matched standard deviations from the mean, and 24-hour urine profiles were assessed. Since 2009, patients with ≥ 1 stone have been prospectively queried about fracture history. Hypercalciuria was defined as Ca/Cr ratio > 0.2 and/or > 4 mg/kg/day. Statistical testing was performed with Fisher's exact and t-test, with p<0.05 considered statistically significant. RESULTS 132 confirmed stone-formers (76F:56M) underwent DXA analysis at average age 12.2 years. Average lumbar and radial forearm BMD Z-scores were −0.8 (range −4.2 to +2.7) and −0.5 (range −2.9 to +2.2), respectively. Lumbar BMD Z-scores were < −1.0 in 51/127 (40.2%) patients, and < −2.0 in 21/127 (16.5%). 79 of 132 children have completed 24-hour urine stone risk analysis, demonstrating 45.6% with hypercalciuria. Table 1 stratifies BMD Z-score based on presence or absence of hypercalciuria. Hypercalciuria was not associated with risk of BMD Z-score < −1 (p=0.36). Among 22 stone-formers who were prospectively queried about bone fracture history, 7 (31.8%) had one or more fractures. Average BMD Z-score in those with versus without fractures was −1.1 and −0.7, respectively. Table 1. DXA results based on presence or absence of hypercalciuria. Non-hypercalciuric Hypercalciuric p-value Total patients (n=79) 43(54.4%) 36(45.6%) Mean lumbar Z-score(SD) −0.9(1.08) −1.0(1.83) 0.76 Z-score < -1, n(%) 22(51.2) 14(38.9) 0.36 Z-score < -2, n(%) 9(20.9) 7(19.4) 1.00 Mean radial Z-score(SD) −0.2(1.35) −0.8(1.46) 0 CONCLUSIONS Pediatric stone disease may identify an at-risk population for future osteoporosis and fractures. Over 40% of our pediatric stone formers had Z-scores < −1.0, a value associated with increased fracture risk in children. Screening DXA scans should be performed in pediatric stone-formers and/or hypercalciurics, particularly in those with a history of fracture. Since adolescence is the period for peak bone mass accrual, it may be the ideal time for dietary and/or medical intervention to decrease future osteoporotic risk. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e551 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Candace Granberg Dallas, TX More articles by this author Katherine Twombley Dallas, TX More articles by this author Aditya Bagrodia Dallas, TX More articles by this author Khashayar Sakhaee Dallas, TX More articles by this author Naim Maalouf Dallas, TX More articles by this author Linda A. Baker Dallas, TX More articles by this author Nicol C. Bush Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...