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Evolution of bone mineral density in patients with idiopathic hypercalciuria: a 20-year longitudinal study

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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.

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Authors and Affiliations

  1. Nephrology Department, Hospital Universitario Insular de Las Palmas de Gran Canaria, Las Palmas, Canary Islands, Spain

    German Perez-Suarez

  2. Pediatric Nephrology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain

    Ma Isabel Luis Yanes & Víctor M. García Nieto

  3. Pediatric Nephrology and Laboratory Services, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain

    Maria Cecilia Martín Fernández de Basoa

  4. Centro de Salud de San Juan de la Rambla, Tenerife, Spain

    Elena Sánchez Almeida

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  1. German Perez-Suarez
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  2. Ma Isabel Luis Yanes
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  3. Maria Cecilia Martín Fernández de Basoa
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  4. Elena Sánchez Almeida
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  5. Víctor M. García Nieto
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Correspondence to German Perez-Suarez.

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The procedures and protocols involved in this study met the ethical, administrative, and data protection requirements of the Pediatrics Department of our hospital, established in accordance with the Spanish laws. The study was carried out in accordance with the Standards of Good Clinical Practice of the European Community and the principles set forth in the Declaration of Helsinki. Patients were adequately informed about the study and signed a written informed consent form.

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Perez-Suarez, G., Yanes, M.I.L., de Basoa, M.C.M.F. et al. Evolution of bone mineral density in patients with idiopathic hypercalciuria: a 20-year longitudinal study. Pediatr Nephrol 36, 661–667 (2021). https://doi.org/10.1007/s00467-020-04754-6

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  • DOI: https://doi.org/10.1007/s00467-020-04754-6

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