Skip to main content
SpringerLink
Log in

Reference range for 24-h urine calcium, calcium/creatinine ratio, and correlations with calcium absorption and serum vitamin D metabolites in normal women

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

A study of 959 black and white women shows that the normal range for 24-h urine calcium excretion in white women is 30–300 mg and 10–285 mg in black women. Clinical laboratories use a normal range for 24-h urine calcium excretion of 100–300 mg; there is a need for them to update their age- and race-specific ranges.

Introduction

Recommendations for a normal range for 24-h urine calcium vary from a low of 50 mg to a high of 400 mg; most “laboratory normal ranges” based on older literature are incorrect. The objective of this analysis is to define a normal range for young women age 25–45 years and older women age 55–90 years, white and black, for 24-h urine calcium and calcium/creatinine ratio, and to examine the relationship between 24-h urine calcium, calcium absorption, and vitamin D metabolites.

Methods

Data from 3 studies was collected on 959 normal black and white women, ages 25–87 years, for 24-h urine calcium, creatinine, calcium intake, serum 25-hydroxyvitamin D (25OHD),1,25 dihydroxyvitamin D (1,25(OH)2D), and calcium absorption. Urine calcium and creatinine were measured on an auto-analyzer. Calcium absorption was measured by a single isotope method. Serum 25OHD and 1,25(OH)2D were measured by competitive protein binding assay or radioimmunoassay. Because 24-h urine calcium did not fit a normal distribution, non-parametric methods were used to determine the 95% reference interval (RI) and 90% non-parametric confidence intervals (CI) calculated for groups.

Results

The 95% reference intervals for 24-h urine calcium for women were as follows: black older 7–225 mg, black younger 8–285 mg; white older 37–275 mg, and white younger 23–287 mg. In older white women, 24-h urine calcium was significantly correlated with serum 1,25(OH)2 D, r = 0.23, p < 0.001, calcium intake r = 0.12, p = 0.001, and calcium absorption r = 0.18, p = 0.003, but not serum 25OHD r = 0.07, p = 0.06.

Conclusions

The normal reference interval for 24-h urine calcium for black women is lower than white women. Twenty-four-hour urine calcium was correlated with serum 1,25(OH)2 D calcium intake and calcium absorption, but not serum 25OHD. This range will be useful clinically for defining hypercalciuria and for following patients on vitamin D and calcium treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Hodgkinson A, Pyrah LN (1958) The urinary excretion of calcium and inorganic phosphate in 344 patients with calcium stone of renal origin. Br J Surg 46(195):10–18. https://doi.org/10.1002/bjs.18004619504

    Article  CAS  PubMed  Google Scholar 

  2. https://www.uclahealth.org/endocrine-center/urine-calcium-test accessed4/14/2020

  3. Watson L, Dale NE (1966) The urinary excretion of calcium, phosphorus and creatinine in normal subjects and in patients with skin cancer. Clin Sci 31(1):77–86

    CAS  PubMed  Google Scholar 

  4. Nordin BEC, Hodgkinson A, Peacock M (1967) The measurement and the meaning of urinary calcium. Clin Orthop Relat Res 52:293–322. https://doi.org/10.1097/00003086-196700520-00023

    Article  CAS  PubMed  Google Scholar 

  5. Bulusu L, Hodgkinson A, Nordin BEC, Peacock M (1970) Urinary excretion of calcium and creatinine in relation to age and body weight in normal subjects and patients with renal calculus. Clin Sci 38(5):601–612. https://doi.org/10.1042/cs0380601

    Article  CAS  PubMed  Google Scholar 

  6. Blackwood AM, Sagnella GA, Cook DG, Cappuccio FP (2001) Urinary calcium excretion, sodium intake and blood pressure in a multi-ethnic population: results of the Wandsworth Heart and Stroke Study. J Hum Hypertens 15(4):229–237. https://doi.org/10.1038/sj.jhh.1001171

    Article  CAS  PubMed  Google Scholar 

  7. Davis RH, Morgan DB, Rivlin RS (1970) The excretion of calcium in the urine and its relation to calcium intake, sex and age. Clin Sci 39(1):1–12. https://doi.org/10.1042/cs0390001

    Article  CAS  PubMed  Google Scholar 

  8. Riggs BL, O’Fallon WM, Muhs J, O’Connor MK, Kumar R, Melton LJ (1998) Long-term effects of calcium supplementation on serum parathyroid hormone level, bone turnover, and bone loss in elderly women. J Bone Miner Res 13(2):168–174. https://doi.org/10.1359/jbmr.1998.13.2.168

    Article  CAS  PubMed  Google Scholar 

  9. Curhan GC, Willett WC, Speizer FE, Stampfer MJ (2001) Twenty-four–hour urine chemistries and the risk of kidney stones among women and men. Kidney Int 59(6):2290–2298. https://doi.org/10.1046/j.1523-1755.2001.00746.x

    Article  CAS  PubMed  Google Scholar 

  10. Meier DE, Luckey MM, Wallenstein S, Clemens TL, Orwoll ES, Waslien CI (1991) Calcium, vitamin D, and parathyroid hormone status in young white and black women: association with racial differences in bone mass*. J Clin Endocrinol Metab 72(3):703–710. https://doi.org/10.1210/jcem-72-3-703

    Article  CAS  PubMed  Google Scholar 

  11. Meier DE, Luckey MM, Wallenstein S, Lapinski RH, Catherwood B (1992) Racial differences in pre- and postmenopausal bone homeostasis: association with bone density. J Bone Miner Res 7(10):1181–1189. https://doi.org/10.1002/jbmr.5650071010

    Article  CAS  PubMed  Google Scholar 

  12. Taylor EN, Curhan GC (2007) Differences in 24-hour urine composition between black and white women. J Am Soc Nephrol 18(2):654–659. https://doi.org/10.1681/ASN.2006080854

    Article  CAS  PubMed  Google Scholar 

  13. Aloia JF, Shieh A, Mikhail M, Islam S (2015) Urinary calcium excretion in postmenopausal African American women. Clin Nephrol 84(09):130–137. https://doi.org/10.5414/CN108548

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Gallagher JC, Fowler SE, Detter JR, Sherman SS (2001) Combination treatment with estrogen and calcitriol in the prevention of age-related bone loss. J Clin Endocrinol Metab 86(8):3618–3628. https://doi.org/10.1210/jcem.86.8.7703

    Article  CAS  PubMed  Google Scholar 

  15. Gallagher JC, Sai A, Templin T, Smith L (2012) Dose response to vitamin D supplementation in postmenopausal women. Ann Intern Med 156(6):425. https://doi.org/10.7326/0003-4819-156-6-201203200-00005

    Article  PubMed  Google Scholar 

  16. Gallagher JC, Yalamanchili V, Smith LM (2012) The effect of vitamin D on calcium absorption in older women. J Clin Endocrinol Metab 97(10):3550–3556. https://doi.org/10.1210/jc.2012-2020

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Gallagher JC, Peacock M, Yalamanchili V, Smith LM (2013) Effects of vitamin D supplementation in older African American women. J Clin Endocrinol Metab 98(3):1137–1146. https://doi.org/10.1210/jc.2012-3106

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Gallagher JC, Jindal PS, Smith LM (2014) Vitamin D supplementation in young white and African American women. J Bone Miner Res 29(1):173–181. https://doi.org/10.1002/jbmr.2010

    Article  CAS  PubMed  Google Scholar 

  19. Geffré A, Friedrichs K, Harr K, Concordet D, Trumel C, Braun J-P (2009) Reference values: a review. Vet Clin Pathol 38(3):288–298. https://doi.org/10.1111/j.1939-165X.2009.00179.x

    Article  PubMed  Google Scholar 

  20. Gallagher JC, Jindal PS, Smith LM (2014) Vitamin D does not increase calcium absorption in young women: a randomized clinical trial. J Bone Miner Res 29(5):1081–1087. https://doi.org/10.1002/jbmr.2121

    Article  CAS  PubMed  Google Scholar 

  21. Cosman F, Morgan DC, Nieves JW, Shen V, Luckey MM, Dempster DW, Lindsay R, Parisien M (1997) Resistance to bone resorbing effects of PTH in black women. J Bone Miner Res 12(6):958–966. https://doi.org/10.1359/jbmr.1997.12.6.958

    Article  CAS  PubMed  Google Scholar 

  22. Smith LM, Gallagher JC (2019) Effect of vitamin D supplementation on total and free 25 hydroxyvitamin D and parathyroid hormone. An analysis of two randomized controlled trials. J Intern Med 286(6):651–659. https://doi.org/10.1111/joim.12950

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Seeger H, Kaelin FPM, Weber D et al (2017) Changes in urinary risk profile after short-term low sodium and low calcium diet in recurrent Swiss kidney stone formers. BMC Nephrol 18(1):349, 2-9. https://doi.org/10.1186/s12882-017-0755-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Bayomy O, Zaheer S, Williams JS, Curhan G, Vaidya A (2020) Disentangling the relationships between the renin-angiotensin-aldosterone system, calcium physiology, and risk for kidney stones. J Clin Endocrinol Metab 105(6):1937–1946. https://doi.org/10.1210/clinem/dgaa123

    Article  Google Scholar 

  25. Sai AJ, Walters RW, Fang X, Gallagher JC (2011) Relationship between vitamin D, parathyroid hormone, and bone health. J Clin Endocrinol Metab 96(3):E436–E446. https://doi.org/10.1210/jc.2010-1886

    Article  CAS  PubMed  Google Scholar 

  26. Gallagher JC, Smith LM, Yalamanchili V (2014) Incidence of hypercalciuria and hypercalcemia during vitamin D and calcium supplementation in older women. Menopause 21(11):1173–1180. https://doi.org/10.1097/GME.0000000000000270

    Article  PubMed  PubMed Central  Google Scholar 

  27. Jackson RD, LaCroix AZ, Gass M et al (2006) Women’s health initiative investigators. Calcium plus vitamin D and the risk of fractures. N Engl J Med 354:669–683

    Article  CAS  Google Scholar 

  28. Bailey RL, Dodd KW, Goldman JA, Gahche JJ, Dwyer JT, Moshfegh AJ, Sempos CT, Picciano MF (2010) Estimation of total usual calcium and vitamin D intakes in the United States. J Nutr 140(4):817–822. https://doi.org/10.3945/jn.109.118539

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Curhan GC, Willett WC, Speizer FE, Spiegelman D, Stampfer MJ (1997) Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann Intern Med 126(7):497–504. https://doi.org/10.7326/0003-4819-126-7-199704010-00001

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Dr Munro Peacock for valuable help in recruiting black women in Indiana for the study. This data was first presented as a poster in the ASBMR meeting in 2013.

Funding

This work was supported by grants from National Institute of Health grants: UO1-AG10373, RO1-AG10358, AG28168, and Department of Defense (DOD) W81XWH-07-1-201. Clinical trial registration: NCT00472823.

Author information

Authors and Affiliations

  1. Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA

    L. M. Smith

  2. Bone Metabolism Unit, Creighton University School of Medicine, Omaha, NE, USA

    J. C. Gallagher

Authors
  1. L. M. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. C. Gallagher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. M. Smith.

Ethics declarations

Conflicts of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Smith, L.M., Gallagher, J.C. Reference range for 24-h urine calcium, calcium/creatinine ratio, and correlations with calcium absorption and serum vitamin D metabolites in normal women. Osteoporos Int 32, 539–547 (2021). https://doi.org/10.1007/s00198-020-05615-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-020-05615-6

Keywords

Search

Navigation