Abstract
BackgroundPatients with urolithiasis have a lower bone mineral density (BMD) than those without stones, suggesting a potential correlation between calcium stone formation and bone resorption disorders, including osteopenia and osteoporosis.MethodsTo investigate the influence of BMD on clinical outcomes in urolithiasis, we performed a single-center retrospective cohort study to analyze patients with urolithiasis who underwent both BMD examination and 24-h urine collection between 2006 and 2015. Data from the national cross-sectional surveillance of the Japanese Society on Urolithiasis Research in 2015 were utilized, and additional data related to urinary tract stones were obtained from medical records. The primary outcome was the development of stone-related symptoms and recurrences during follow-up. A total of 370 patients were included in this 10-year study period.ResultsHalf of the patients had recurrent stones, and the two-thirds were symptomatic stone formers. While only 9% of patients had hypercalciuria, 27% and 55% had hyperoxaluria and hypocitraturia, respectively. There was a positive correlation between T-scores and urinary citrate excretion. Both univariate and multivariate analyses demonstrated that female sex was associated with recurrences (odds ratio = 0.44, p = 0.007), whereas a T-score < − 2.5 and hyperoxaluria were associated with symptoms (odds ratio = 2.59, p = 0.037; odds ratio = 0.45, p = 0.01; respectively).ConclusionThese results revealed that low T-scores might cause symptoms in patients with urolithiasis, suggesting the importance of BMD examination for high-risk Japanese patients with urolithiasis having hypocitraturia.
Highlights
Patients with urolithiasis have a lower bone mineral density (BMD) than those without stones, suggesting a potential correlation between calcium stone formation and bone resorption disorders, including osteopenia and osteoporosis
This study aimed to evaluate the association between BMD and clinical outcomes in urolithiasis, including mineral parameters such as 24-h urine collection and symptoms and incidence of recurrences
The sex comparison revealed that female patients were significantly younger at both disease onset and clinic visits and had lower Body mass index (BMI), lower recurrence rates, lower BMD and T-score/Z-scores, higher serum phosphate and urinary pH, and lower urinary phosphate, sodium, and oxalate excretion than male patients
Summary
Patients with urolithiasis have a lower bone mineral density (BMD) than those without stones, suggesting a potential correlation between calcium stone formation and bone resorption disorders, including osteopenia and osteoporosis. Especially those whose stones are composed of calcium oxalate and phosphate, are reported to have abnormal mineral laboratory findings, such as hypercalcemia and hypercalciuria, as well as bone metabolic symptoms including fractures [6]. The bone mineral density (BMD) of patients with urolithiasis is lower than that of those without stones [7]; even the male adolescent population demonstrates similar findings [8]. Osteoporotic states often cause hypercalciuria in patients with urolithiasis due to deterioration in bone resorption [9]. This evidence indicates that the pathogenesis of urolithiasis is linked to osteogenesis via mineral metabolism
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