Quelle est la ration calcique optimale chez le sujet souffrant de lithiase calcique ?

Abstract

Calcium stone disease is a very common disease in developed countries and hypercalciuria is the most frequent urinary risk factor. However prospective epidemiological studies have clearly demonstrated that the risk of stone formation is inversely related to dietary calcium intake. Moreover the potential value of a low calcium diet to prevent stone recurrence has been discarded in a recent prospective trial. In hypercalciuric calcium stone formers, a lowered incidence of stone recurrence was observed in patients ingesting a 1.2 g daily calcium diet comparatively to patients taking a low calcium diet (400 mg/day). A higher aggregation of oxalate by dietary calcium in the gut leaves a low amount of free oxalate directly available for absorption in the colon.The higher calcium intake is as well beneficial for the bone since bone mineral vertebral density is decreased in calcium stone-formers and at a greater extent in hypercalciuric patients. In addition epidemiological studies have shown an increase in the prevalence of vertebral fractures in stone-formers.In conclusion to prevent stone recurrence and to protect their bone, patients with calcium stone formation should be adviced a normal calcium diet (1 g/day). To prevent an increase in urinary calcium, a low sodium diet is mandatory to reduce further calcium excretion and to reinforce the hypocalciuric effect of thiazide diuretics when necessary.