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Prevention of stone formation and bone loss in absorptive hypercalciuria by combined dietary and pharmacological interventions.

Abstract

PURPOSE

We determined whether dietary restriction of calcium and oxalate, combined with thiazide and potassium citrate treatment, would prevent stone formation and avert bone loss in 18 men and 10 women with type I absorptive hypercalciuria.

MATERIALS AND METHODS

Patients were treated with thiazide (20) or indapamide (8) and potassium citrate (average dose 35 mEq. daily) for 1 to 11 years (mean 3.7) while maintained on low calcium oxalate diet. Serum and urinary chemistry studies and bone mineral density were measured at baseline and at the end of treatment. New stones formed were quantitated during 3 years before and during treatment.

RESULTS

During treatment urinary calcium significantly decreased (346 +/- 85 to 248 +/- 79 mg. daily, p <0.001) but urinary oxalate did not change. Urinary pH and citrate significantly increased, and urinary saturation of calcium oxalate significantly decreased by 46%. Stone formation rate decreased significantly from 2.94 to 0.05 per year (p <0.001). L2-L4 bone mineral density increased significantly by 5.7% compared to normal peak value, and by 7.1% compared with normal age and gender matched value. Femoral neck bone mineral density also increased significantly.

CONCLUSIONS

Dietary restriction of calcium and oxalate, combined with thiazide and potassium citrate, satisfactorily controlled hypercalciuria, prevented the secondary increase in urinary oxalate, reduced urinary saturation of calcium oxalate, virtually eliminated recurrent stone formation, and increased bone density of the spine and femoral neck. Thus, this dietary pharmacological program controlled stone formation as well as bone loss that often accompany type 1 absorptive hypercalciuria.

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  • Authors+Show Affiliations

    ,

    Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas 75390-8885, USA.

    , , , ,

    Source

    The Journal of urology 169:2 2003 Feb pg 465-9

    MeSH

    Absorption
    Adult
    Benzothiadiazines
    Bone Resorption
    Calcium
    Calcium, Dietary
    Combined Modality Therapy
    Diet
    Diuretics
    Female
    Humans
    Kidney Calculi
    Male
    Middle Aged
    Oxalates
    Potassium Citrate
    Sodium Chloride Symporter Inhibitors

    Pub Type(s)

    Journal Article
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    12544288

    Citation

    Pak, Charles Y., et al. "Prevention of Stone Formation and Bone Loss in Absorptive Hypercalciuria By Combined Dietary and Pharmacological Interventions." The Journal of Urology, vol. 169, no. 2, 2003, pp. 465-9.
    Pak CY, Heller HJ, Pearle MS, et al. Prevention of stone formation and bone loss in absorptive hypercalciuria by combined dietary and pharmacological interventions. J Urol. 2003;169(2):465-9.
    Pak, C. Y., Heller, H. J., Pearle, M. S., Odvina, C. V., Poindexter, J. R., & Peterson, R. D. (2003). Prevention of stone formation and bone loss in absorptive hypercalciuria by combined dietary and pharmacological interventions. The Journal of Urology, 169(2), pp. 465-9.
    Pak CY, et al. Prevention of Stone Formation and Bone Loss in Absorptive Hypercalciuria By Combined Dietary and Pharmacological Interventions. J Urol. 2003;169(2):465-9. PubMed PMID: 12544288.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Prevention of stone formation and bone loss in absorptive hypercalciuria by combined dietary and pharmacological interventions. AU - Pak,Charles Y, AU - Heller,Howard J, AU - Pearle,Margaret S, AU - Odvina,Clarita V, AU - Poindexter,John R, AU - Peterson,Roy D, PY - 2003/1/25/pubmed PY - 2003/2/26/medline PY - 2003/1/25/entrez KW - Non-programmatic SP - 465 EP - 9 JF - The Journal of urology JO - J. Urol. VL - 169 IS - 2 N2 - PURPOSE: We determined whether dietary restriction of calcium and oxalate, combined with thiazide and potassium citrate treatment, would prevent stone formation and avert bone loss in 18 men and 10 women with type I absorptive hypercalciuria. MATERIALS AND METHODS: Patients were treated with thiazide (20) or indapamide (8) and potassium citrate (average dose 35 mEq. daily) for 1 to 11 years (mean 3.7) while maintained on low calcium oxalate diet. Serum and urinary chemistry studies and bone mineral density were measured at baseline and at the end of treatment. New stones formed were quantitated during 3 years before and during treatment. RESULTS: During treatment urinary calcium significantly decreased (346 +/- 85 to 248 +/- 79 mg. daily, p <0.001) but urinary oxalate did not change. Urinary pH and citrate significantly increased, and urinary saturation of calcium oxalate significantly decreased by 46%. Stone formation rate decreased significantly from 2.94 to 0.05 per year (p <0.001). L2-L4 bone mineral density increased significantly by 5.7% compared to normal peak value, and by 7.1% compared with normal age and gender matched value. Femoral neck bone mineral density also increased significantly. CONCLUSIONS: Dietary restriction of calcium and oxalate, combined with thiazide and potassium citrate, satisfactorily controlled hypercalciuria, prevented the secondary increase in urinary oxalate, reduced urinary saturation of calcium oxalate, virtually eliminated recurrent stone formation, and increased bone density of the spine and femoral neck. Thus, this dietary pharmacological program controlled stone formation as well as bone loss that often accompany type 1 absorptive hypercalciuria. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/12544288/Prevention_of_stone_formation_and_bone_loss_in_absorptive_hypercalciuria_by_combined_dietary_and_pharmacological_interventions_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5347(05)63934-1 DB - PRIME DP - Unbound Medicine ER -