Predictors of Bone Mineral Density in Kidney Stone Formers

Nephrolithiasis is associated with an increased fracture risk, but predictors of bone mineral density (BMD) in stone formers (SFs) remain poorly defined.

We conducted a retrospective analysis in the Bern Kidney Stone Registry (BKSR), an observational cohort of kidney SFs. Inclusion criteria were age ≥18 years and ≥1 past stone episode. Participants with non-calcium (Ca)-containing kidney stones, a history of primary hyperparathyroidism or antiresorptive or anabolic bone treatment were excluded. Multivariable linear regression analyses were used to assess the association of blood and 24-hours urine parameters and stone composition with BMD at the lumbar spine and femoral neck.

In the analysis, 504 participants were included, mean age was 46 years, and 76% were male. In multivariable analyses, fasting (β: -0.031; P = 0.042), postload (β: -0.059; P = 0.0028) and Δ postload - fasting (β: -0.053; P = 0.0029) urine Ca-to-creatinine ratios after 1 week of a sodium- and Ca- restricted diet and Ca oxalate dihydrate stone content (β: -0.042; P = 0.011) were negatively associated with z scores at the lumbar spine. At the femoral neck, alkaline phosphatase (β: -0.035; P = 0.0034) and parathyroid hormone (PTH) (β: -0.035; P = 0.0026) were negatively associated with z scores, whereas 24-hours urine Ca (β: 0.033; P = 0.0085), magnesium (β: 0.043; P = 3.5 × 10^-4), and potassium (β: 0.032; P = 0.012) correlated positively with z scores at the femoral neck.

Our study reveals distinct predictors of BMD in SFs. Commonly available clinical parameters, such as kidney stone composition results, can be used to identify SFs at risk for low BMD.