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Bone mineral density in adolescent urinary stone formers: is sex important?

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Abstract

Urinary stone disease (USD) is affecting a greater number of children and low bone mineral density (BMD) and increased skeletal fractures have been demonstrated in stone patients; however, the mechanism(s) driving bone disease remain unclear. This pilot study was undertaken to assess an adolescent kidney stone cohort’s BMD and evaluate for an inverse correlation between BMD and urine concentration of lithogenic minerals and/or inflammatory levels. Prospective case–control study was carried out at a large pediatric center. 15 participants with USD (12–18 years of age, 8 female) were matched by age, sex, and body mass index to 15 controls. Lumbar and total body BMD z-score did not differ between groups. When stone formers were separated by sex, there was a significant difference between male stone formers vs. controls total body BMD z-score (Fig. 1). BMD z-score did not significantly correlate with urine calcium, oxalate, citrate or magnesium. Higher urine IL-13 did significantly correlate with higher total body BMD z-score (r = 0.677, p = 0.018). Total body BMD z-score did significantly correlate with body mass index (BMI) as expected for the control group (r = 0.6321, p = 0.0133). However, this relationship was not present in the USD group (r = − 0.1629, p = 0.5619). This is a small but hypothesis-generating study which demonstrates novel evidence of male-specific low BMD in adolescent stone formers. Furthermore, we demonstrated a positive association between urine IL-13 and total body BMD z-score USD patients as well as a lack of a positive BMD and BMI correlations in stone formers.

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Funding

Grant number 977089-7 [KK] Intramural Foundation Grant Akron Children’s Hospital.

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Authors and Affiliations

  1. Division of Nephrology, Akron Children’s Hospital, Akron, OH, USA

    Kirsten Kusumi & Rupesh Raina

  2. Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA

    Andrew L. Schwaderer

  3. Division of Urology, Akron Children’s Hospital, Akron, OH, USA

    Curtis Clark

  4. Northeast Ohio Medical University, Rootstown, OH, USA

    Kirsten Kusumi, Kevin Budge, Nazar Hussein & Fayez Safadi

  5. Division of Nephrology, Akron General Cleveland Clinic, Akron, OH, USA

    Rupesh Raina

  6. Division of Nephrology, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Michelle Denburg

Authors
  1. Kirsten Kusumi
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  2. Andrew L. Schwaderer
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  3. Curtis Clark
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  4. Kevin Budge
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  5. Nazar Hussein
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  6. Rupesh Raina
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  7. Michelle Denburg
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  8. Fayez Safadi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by KK, AS, RR, MD, KB, NH, CC, and FS. The first draft of the manuscript was written by KK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Kirsten Kusumi.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (ACH Institutional Review Board: 977089-8) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Kusumi, K., Schwaderer, A.L., Clark, C. et al. Bone mineral density in adolescent urinary stone formers: is sex important?. Urolithiasis 48, 329–335 (2020). https://doi.org/10.1007/s00240-020-01183-w

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  • DOI: https://doi.org/10.1007/s00240-020-01183-w

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