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Impact of urinary calcium excretion on kidney, bone, and cardiovascular systems in patients with bone biopsy proven osteoporosis: a longitudinal long-term follow-up study

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Abstract

Summary

The impact of urine calcium on kidney, bone, and cardiovascular systems in osteoporosis is not well-known. In this 7-year-follow-up study, high urine calcium did not affect kidney function but increased risk of kidney stones, while low urine calcium increased cardiovascular diseases. Maintaining normal urine calcium is beneficial for bone health.

Purpose

Hypercalciuria is common in patients with osteoporosis. However, the long-term effect of urinary calcium excretion (UCaE) on patients’ health is not well-examined. The current study aims to assess the impact of UCaE on kidney, bone, and cardiovascular outcomes in patients with bone biopsy proven osteoporosis.

Methods

Longitudinal study of all patients with osteoporosis who underwent bone biopsy and 24-h urine collection between 2008 and 2015 in the University of Kentucky. DXA scans, serum markers, kidney function, and cardiovascular events were recorded until last clinic visit in 2021. Exclusion criteria were secondary osteoporosis or conditions that might substantially impact UCaE. The significant results in univariate analysis were confirmed in multi-variable regression models involving clinically important covariates that might impact patients’ outcomes.

Results

Study included 230 patients with mean follow-up of 7.2 ± 2.9 years. The mean age was 61 years, and the mean eGFR at baseline was 85 ± 19 ml/min/1.73 m2. Low bone turnover (LBT) was present in 57% and high bone turnover (HBT) in 43% of patients. Hypercalciuria was found in one-third of patients with no difference between LTB and HTB. UCaE correlated positively with eGFR but did not affect the rate of eGFR decline over time. Higher UCaE predicted kidney stones development. We observed U-shaped effect of UCaE on bone health. Hypercalciuria predicted loss of BMD at all sites, but also hypocalciuria was associated with higher loss in total hip BMD. Upper limb fractures were the most observed fractures, and their incidence was higher in patients with hyper- or hypo-calciuria. Lower UCaE independently predicted development of major adverse cardiac events (MACE) and cardiovascular disease (CVD).

Conclusion

UCaE correlated with eGFR but it did not affect the change of eGFR over time. Patients with normal UCaE had lower incidence of upper limb fractures and less reduction in BMD. Low UCaE predicted MACE and CVD.

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Funding

Mohamed Abdalbary was supported by the International Society of Nephrology (ISN) fellowship during his participation in this study.

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Authors and Affiliations

  1. Mansoura Nephrology and Dialysis Unit, Mansoura University, 1 El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt

    M. Abdalbary, M.K. Nassar & N. Sayed-Ahmed

  2. Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, USA

    M. Abdalbary, E. Chishti, M. Shakhashiro, R. Mohamed, T. Parikh, M.-C. Faugere, B.P. Sawaya & A. El-Husseini

Authors
  1. M. Abdalbary
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  2. E. Chishti
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  3. M. Shakhashiro
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  4. R. Mohamed
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  5. T. Parikh
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  6. M.K. Nassar
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  8. M.-C. Faugere
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  9. B.P. Sawaya
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  10. A. El-Husseini
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Correspondence to M. Abdalbary.

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Supplementary information

Supplementary materials 1:

Supplementary Table 1: Significant correlations between baseline UCaE and baseline results. Supplementary Table 2: Binary logistic regression for development of new kidney stones. Supplementary Table 3: Urinary laboratory parameters among patients with and without kidney stones.

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Abdalbary, M., Chishti, E., Shakhashiro, M. et al. Impact of urinary calcium excretion on kidney, bone, and cardiovascular systems in patients with bone biopsy proven osteoporosis: a longitudinal long-term follow-up study. Osteoporos Int 34, 763–774 (2023). https://doi.org/10.1007/s00198-023-06686-x

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