Could kidney stones help clinicians identify patients at risk for osteoporosis? A new study from Stanford University has found a possible link between kidney stone disease and the risk of osteoporosis or bone fractures.
A study of more than half a million patients with kidney stone disease, results show that nearly 1 in 4 patients have been diagnosed with osteoporosis or have suffered a bone fracture and recommend screening of these patients for increased risk remains subpar.
“We hope this work raises awareness of the potential for lower bone strength in patients with kidney stones. In our future work, we hope to identify who the patients with kidney stones are. who are at higher risk for osteoporosis or fracture to help direct bone density screening efforts by clinicians in this population, ”said lead researcher Calyani Ganesan, MD, a nephrology fellow at Stanford University, in a statement.
With osteoporosis and fractures a major threat to the well-being and quality of life of an aging adult, Ganesan and colleagues from Stanford University sought to determine whether kidney stone disease was associated with an increased risk for osteoporosis. Researchers designed their analysis as a retrospective cohort study using data from the Veterans Health Administration database.
Patients with kidney stone disease were considered if they had at least one encounter with patients who included ICD-9 and ICD-10 codes for kidney or ureteral stones. In total, studies identify 531,431 patients with treated kidney stone disease. Between January 1, 2007- December 3, 2015. Of these, 125,427 experienced osteoporosis or fracture in the previous 5 years or 5 years after index stone diagnosis. Of the 125,527, 32,613 (6.1%) were diagnosed with osteoporosis.
In modified models, the results suggested the presence of type 2 diabetes (OR, 1.07; 95% CI, 1.05–1.09), metastatic cancer (OR, 1.15; 95% CI, 1.11–1.20), enteric disease (OR, 1.19; 95% CI, 1.08–1.31), hypogonadism (OR, 1.22; 95% CI, 1.14–1.29), and primary hyperparathyroidism (OR, 1.59; 95% CI, 1.43–1.76) were associated with risk more likely to be diagnosed with fracture or osteoporosis after an index stone diagnosis.
When assessing levels of dual-energy X-ray absorptiometry (DXA) among those who had no history of osteoporosis or fracture before a kidney stone was diagnosed, researchers found just 9.1% (n = 42,329) of patients who met these criteria under DXA in the 5 years after the initial diagnosis. Of those who underwent DXA, 20% were subsequently diagnosed with osteoporosis, 19% (n = 8055) were diagnosed with non-hip fracture, and 2.4% (n = 1008) were diagnosed with hip fracture. Researchers identified that 85% of patients screened and subsequently diagnosed with osteoporosis were male.
Further analysis indicated that the rates of DXA screening were higher among patients with a history of hypogonadism (OR = 2.07; 95% CI 1.95–2.20) or primary hyperparathyroidism (OR = 4.99; 95% CI 4.57 –5.44). In addition, results suggested that patients had a reduction in DXA intake if they had a history of metastatic cancer (OR, 0.93; 95% CI, 0.88–0.98).
“Our findings support the wider use of bone mineral density screening in patients with kidney stone disease, including middle-aged and elderly men, whose efforts are not stressed. to reduce the risks of osteoporosis and fractures, ”wrote researchers.
This study, “Osteoporosis, fracture, and bone mineral density screening in veterans with kidney stone disease,” was published in the Journal of Bone and Mineral Research.