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Low Bone Density and Bisphosphonate Use and the Risk of Kidney Stones.
Clin J Am Soc Nephrol 2017; 12(8):1284-1290CJ

Abstract

BACKGROUND AND OBJECTIVES

Previous studies have demonstrated lower bone density in patients with kidney stones, but no longitudinal studies have evaluated kidney stone risk in individuals with low bone density. Small studies with short follow-up reported reduced 24-hour urine calcium excretion with bisphosphonate use. We examined history of low bone density and bisphosphonate use and the risk of incident kidney stone as well as the association with 24-hour calcium excretion.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We conducted a prospective analysis of 96,092 women in the Nurses' Health Study II. We used Cox proportional hazards models to adjust for age, body mass index, thiazide use, fluid intake, supplemental calcium use, and dietary factors. We also conducted a cross-sectional analysis of 2294 participants using multivariable linear regression to compare 24-hour urinary calcium excretion between participants with and without a history of low bone density, and among 458 participants with low bone density, with and without bisphosphonate use.

RESULTS

We identified 2564 incident stones during 1,179,860 person-years of follow-up. The multivariable adjusted relative risk for an incident kidney stone for participants with history of low bone density compared with participants without was 1.39 (95% confidence interval [95% CI], 1.20 to 1.62). Among participants with low bone density, the multivariable adjusted relative risk for an incident kidney stone for bisphosphonate users was 0.68 (95% CI, 0.48 to 0.98). In the cross-sectional analysis of 24-hour urine calcium excretion, the multivariable adjusted mean difference in 24-hour calcium was 10 mg/d (95% CI, 1 to 19) higher for participants with history of low bone density. However, among participants with history of low bone density, there was no association between bisphosphonate use and 24-hour calcium with multivariable adjusted mean difference in 24-hour calcium of -2 mg/d (95% CI, -25 to 20).

CONCLUSIONS

Low bone density is an independent risk factor for incident kidney stone and is associated with higher 24-hour urine calcium excretion. Among participants with low bone density, bisphosphonate use was associated with lower risk of incident kidney stone but was not independently associated with 24-hour urine calcium excretion.

Authors+Show Affiliations

Divisions of Renal Medicine and mprochaska@partners.org. Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and.Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and. Division of Nephrology and Transplantation, Maine Medical Center, Portland, Maine.Endocrinology, Diabetes, and Hypertension, and.Divisions of Renal Medicine and. Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28576907

Citation

Prochaska, Megan, et al. "Low Bone Density and Bisphosphonate Use and the Risk of Kidney Stones." Clinical Journal of the American Society of Nephrology : CJASN, vol. 12, no. 8, 2017, pp. 1284-1290.
Prochaska M, Taylor E, Vaidya A, et al. Low Bone Density and Bisphosphonate Use and the Risk of Kidney Stones. Clin J Am Soc Nephrol. 2017;12(8):1284-1290.
Prochaska, M., Taylor, E., Vaidya, A., & Curhan, G. (2017). Low Bone Density and Bisphosphonate Use and the Risk of Kidney Stones. Clinical Journal of the American Society of Nephrology : CJASN, 12(8), pp. 1284-1290. doi:10.2215/CJN.01420217.
Prochaska M, et al. Low Bone Density and Bisphosphonate Use and the Risk of Kidney Stones. Clin J Am Soc Nephrol. 2017 Aug 7;12(8):1284-1290. PubMed PMID: 28576907.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low Bone Density and Bisphosphonate Use and the Risk of Kidney Stones. AU - Prochaska,Megan, AU - Taylor,Eric, AU - Vaidya,Anand, AU - Curhan,Gary, Y1 - 2017/06/02/ PY - 2017/02/07/received PY - 2017/05/05/accepted PY - 2017/6/4/pubmed PY - 2018/5/1/medline PY - 2017/6/4/entrez KW - Body Mass Index KW - Bone Density KW - Calcium, Dietary KW - Cross-Sectional Studies KW - Diphosphonates KW - Epidemiologic Studies KW - Female KW - Follow-Up Studies KW - Humans KW - Kidney Calculi KW - Linear Models KW - Proportional Hazards Models KW - Prospective Studies KW - Risk Assessment KW - Thiazides KW - risk factors SP - 1284 EP - 1290 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 12 IS - 8 N2 - BACKGROUND AND OBJECTIVES: Previous studies have demonstrated lower bone density in patients with kidney stones, but no longitudinal studies have evaluated kidney stone risk in individuals with low bone density. Small studies with short follow-up reported reduced 24-hour urine calcium excretion with bisphosphonate use. We examined history of low bone density and bisphosphonate use and the risk of incident kidney stone as well as the association with 24-hour calcium excretion. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a prospective analysis of 96,092 women in the Nurses' Health Study II. We used Cox proportional hazards models to adjust for age, body mass index, thiazide use, fluid intake, supplemental calcium use, and dietary factors. We also conducted a cross-sectional analysis of 2294 participants using multivariable linear regression to compare 24-hour urinary calcium excretion between participants with and without a history of low bone density, and among 458 participants with low bone density, with and without bisphosphonate use. RESULTS: We identified 2564 incident stones during 1,179,860 person-years of follow-up. The multivariable adjusted relative risk for an incident kidney stone for participants with history of low bone density compared with participants without was 1.39 (95% confidence interval [95% CI], 1.20 to 1.62). Among participants with low bone density, the multivariable adjusted relative risk for an incident kidney stone for bisphosphonate users was 0.68 (95% CI, 0.48 to 0.98). In the cross-sectional analysis of 24-hour urine calcium excretion, the multivariable adjusted mean difference in 24-hour calcium was 10 mg/d (95% CI, 1 to 19) higher for participants with history of low bone density. However, among participants with history of low bone density, there was no association between bisphosphonate use and 24-hour calcium with multivariable adjusted mean difference in 24-hour calcium of -2 mg/d (95% CI, -25 to 20). CONCLUSIONS: Low bone density is an independent risk factor for incident kidney stone and is associated with higher 24-hour urine calcium excretion. Among participants with low bone density, bisphosphonate use was associated with lower risk of incident kidney stone but was not independently associated with 24-hour urine calcium excretion. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/28576907/Low_Bone_Density_and_Bisphosphonate_Use_and_the_Risk_of_Kidney_Stones_ L2 - http://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=28576907 DB - PRIME DP - Unbound Medicine ER -