Many patients with kidney stones concurrently have or later experience osteoporosis or fracture, a new study of veterans suggests, but not enough receive bone mineral density screening.
In the US Veterans Health Administration database, 531,431 patients had a kidney stone diagnosis during 2007 to 2015. Nearly 1 in 4 of these patients (23.6%) also had a coincident diagnosis of osteoporosis or fracture, Calyani Ganesan, MD, of Stanford University in Palo Alto, California, and colleagues reported in the Journal of Bone and Mineral Research. The mean age of these patients was 64.2 years; 91.2% were men, and 8.8% were women. Non-hip fracture, osteoporosis, and hip fracture occurred in 19.0%, 6.1%, and 2.1% of these patients, they reported. According to a sex-stratified analysis, 23% of male and 34% of female veterans with kidney stones had concurrent osteoporosis or fracture. Black veterans (13.9% of cohort) had significant 20% lower odds of these diagnoses compared with White veterans.
The investigators examined clinical factors associated with a diagnosis of osteoporosis or fractures. Having type 2 diabetes, metastatic cancer, inflammatory bowel disease, hypogonadism, or primary hyperparathyroidism significantly increased the odds of an osteoporosis or fracture diagnosis. By contrast, having higher levels of 24-hour urinary citrate excretion decreased the odds of these bone-related diagnoses. No correlation was observed for 24-hour urinary calcium excretion. The researchers were unable to investigate 24-hour urinary sodium, potassium, magnesium, or phosphate.
Dr Ganesan’s team found subpar use of bone mineral density screening with dual-energy X-ray absorptiometry (DXA) in veterans with kidney stone disease. Among those with no history of osteoporosis or bone mineral density assessment, only 9.1% were screened with DXA within 5 years of their kidney stone diagnosis; of these, 20% were subsequently diagnosed with osteoporosis, 19% with non-hip fracture, and 2.4% with hip fracture.
“Our findings provide support for wider use of bone mineral density screening in patients with kidney stone disease, including men, so that osteoporosis can be diagnosed and treated earlier to prevent fractures,” the investigators concluded.
Ganesan C, Thomas I-C, Romero R, et al. Osteoporosis, fractures, and bone mineral density screening in veterans with kidney stone disease. J Bone Miner Res. Published online March 3, 2021. doi:10.1002/jbmr.4260