Disclosures: The authors report no relevant financial disclosures.
March 03, 2021
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Kidney stones may signal reduced bone strength, fracture risk

Disclosures: The authors report no relevant financial disclosures.
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Approximately one-quarter of adults with kidney stone disease had a diagnosis of osteoporosis or bone fracture at the time of their kidney stone diagnosis, according to a Veterans Affairs database analysis.

“There is a high prevalence of bone disease among patients with kidney stones, yet only a small proportion of patients with kidney stones receive bone density screening,” Calyani Ganesan, MD, MS, a clinical scholar and postdoctoral research fellow in the division of nephrology at Stanford University, told Healio. “The risk of bone disease in patients with kidney stones is currently underappreciated. Clinicians should consider bone density screening in patients with kidney stones to detect osteoporosis and initiate treatment to prevent fractures.”

Ganesan is a clinical scholar and postdoctoral research fellow in the division of nephrology at Stanford University.

The findings were published in the Journal of Bone and Mineral Research.

In a retrospective study, Ganesan and colleagues analyzed VA data for 531,431 patients with kidney stone disease between 2007 and 2015. To determine the prevalence of osteoporosis or fracture, researchers identified patients with kidney stone disease who had a diagnosis of osteoporosis or fracture in the 5 years before or after their index kidney stone diagnosis.

Within the cohort, nearly 1 in 4 patients (23.6%) with kidney stone disease had a diagnosis of osteoporosis or fracture around the time of kidney stone diagnosis (95% CI, 23.5-23.7).

Among VA patients with no history of osteoporosis or DXA measurement before a kidney stone diagnosis, 9.1% were screened with DXA after their kidney stone diagnosis. The most common diagnosis was a non-hip fracture (19%), followed by osteoporosis (6.1%) and hip fracture (2.1%). The mean age of people with kidney stone disease and osteoporosis or fracture was 64 years (91.2% men).

Among veterans with kidney stone disease and no history of osteoporosis or fracture, 12.2% had administrative claims for osteoporosis or fracture in the 5 years after a kidney stone disease diagnosis. The most common diagnosis was non-hip fracture (10.3%), followed by osteoporosis (3.1%) and hip fracture (1.6%).

Ganesan said the findings support wider use of DXA screening for people with kidney stone disease, including middle-aged and older men, a group less well recognized as at risk for osteoporosis or fractures.

“Future work identifying which patients with kidney stones are at highest risk for fracture and the effects of anti-osteoporosis medications on kidney stone recurrence are necessary,” Ganesan said. “This would hopefully lead to more effective screening and management of osteoporosis in patients with kidney stones.”

For more information:

Calyani Ganesan, MD, MS, can be reached at calyani@stanford.edu.