Evolution of bone mineral density in patients with idiopathic hypercalciuria: a 20-year longitudinal study
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ORIGINAL ARTICLE
Evolution of bone mineral density in patients with idiopathic hypercalciuria: a 20-year longitudinal study German Perez-Suarez 1 & Ma Isabel Luis Yanes 2 & Maria Cecilia Martín Fernández de Basoa 3 & Elena Sánchez Almeida 4 & Víctor M. García Nieto 2 Received: 12 April 2020 / Revised: 6 July 2020 / Accepted: 1 September 2020 # IPNA 2020
Abstract Background Several recent studies reported bone mineral density (BMD) reduction in pediatric patients with idiopathic hypercalciuria (IH). This longitudinal study aimed to evaluate BMD evolution in IH patients through three bone densitometry studies conducted over 20 years on average. A second objective was to evaluate urine calcium and citrate excretion during this period. Methods Case notes of 34 patients diagnosed with IH at age 7.9 ± 3, alongside results of two bone densitometry studies, performed at 10.5 ± 2.7 (BMD1) and 14.5 ± 2.7 (BMD2) years of age, were reviewed. Patients underwent a third densitometry study in adulthood (BMD3) aged 28.3 ± 2.9. Mean follow-up duration (time-lapse between BMD1 and BMD3) was 17.7 ± 1.4 years. Results Statistically significant differences were found between z-BMD3 (− 0.85 ± 1.10) and z-BMD1 (− 1.47 ± 0.99) (P = 0.001) as well as between z-BMD3 and z-BMD2 (− 1.33 ± 1.20) (P = 0.016). At the end of follow-up, z-BMD3 was superior to z-BMD2 in 23 adult patients (67.6%) and lower in 11 patients (5M, 6F; 32.3%). Both men and women showed increased bone mass over time, although such increases were significant only for women. The gradual decrease observed in calcium/creatinine and citrate/creatinine ratios could be related to improvement in osteoblastic activity and especially reduction in osteoclastic activity. Conclusions In patients with IH, BMD improves, which may be related especially to female sex, increment of body mass, and reduction in bone resorption. Upon reaching adulthood, urine calcium and citrate excretion tend to decrease so lithogenic risk still remains. The cause of the latter is unknown, although it likely relates to changes in bone activity. Keywords Idiopathic hypercalciuria . Bone mineral density . Hypocitraturia . Lithogenic risk
Introduction In 1976, Alhava et al. reported bone mineral density (BMD) reduction in adult patients with nephrolithiasis [1]. Since then, it has been recognized that patients with calcium stones
* German Perez-Suarez [email protected] 1
Nephrology Department, Hospital Universitario Insular de Las Palmas de Gran Canaria, Las Palmas, Canary Islands, Spain
2
Pediatric Nephrology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain
3
Pediatric Nephrology and Laboratory Services, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain
4
Centro de Salud de San Juan de la Rambla, Tenerife, Spain
secondary to idiopathic hypercalciuria (IH) may exhibit a decrease in BMD [2, 3]. Several factors may be involved in bone mass loss in IH, including increased prostaglandin E2 production [4
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