This study assessed the presence of osteoporosis/osteopenia in patients with severe lithogenic activity and compared their metabolisms with those in patients without lithiasis or with mild lithogenic ...activity.
From a sample of 182 patients, those with osteopenia/osteoporosis at the hip and lumbar spine were studied separately in a two-pronged study. 66 patients with bone mineral densities (BMDs) < -1 standard deviation (SD) on a T-score scale at the hip were divided into three groups: group A1 without lithiasis (n = 15); group A2 with lithiasis and mild lithogenic activity (n = 22); and group A3 with lithiasis and severe lithogenic activity (n = 29). Similarly, 86 patients with BMDs < -1 SD on a T-score scale at the lumbar spine were divided into three groups: group B1 without lithiasis (n = 15); group B2 with lithiasis and mild lithogenic activity (n = 29); and group B3 with lithiasis and severe lithogenic activity (n = 42).
Patients from group A3 exhibited significantly higher levels of bone remodelling markers as compared to groups A1 and A2. Urinalysis also revealed higher excretion of calcium in 24-hour assessments in this group. Patients from group B3 differed from groups B1 and B2 mainly in bone remodelling markers and 24-hour urinary calcium excretion, which were significantly elevated in patients from group B3.
Patients with calcium lithiasis and severe lithogenic activity in addition to osteopenia/osteoporosis present with higher levels of hypercalciuria and negative osseous balance, which possibly perpetuate and favour lithiasic activity.
The aim of this study was to analyze the presence of lithogenic metabolic factors in the blood and urine of patients with osteopenia versus osteoporosis. This is a cross-sectional study including 67 ...patients who were divided into two groups according to the presence of either osteopenia or osteoporosis as measured by bone densitometry: group 1—40 patients with osteopenia (22 men and 18 women) and group 2—27 patients with osteoporosis (13 men and 14 women). Metabolic studies were performed on the blood and urine; statistical analysis was performed comparing means and conducting linear correlation and multivariate analyses with SPSS. Statistical significance was considered to be
p
≤ 0.05. The mean age of patients in group 1 was 52.9 ± 12.8 years versus 50.3 ± 11.4 in group 2; the difference was not statistically significant. In group 2, higher levels of osteocalcin, β-crosslaps, urinary calcium, fasting urine calcium/creatinine, 24 h urine calcium/creatinine and 24 h oxaluria were observed compared to group 1. In the multivariate analysis, only the β-crosslaps and urinary calcium were independently associated with osteoporosis. It would be advisable to determine the urinary calcium levels in patients with osteoporosis since altered levels may necessitate modifying the diagnostic and therapeutic approach to osteoporosis.
Purpose
To analyze the presence of phosphocalcic metabolism disorders in patients with osteopenia–osteoporosis without nephrolithiasis with respect to a control group.
Methods
A cross-sectional study ...was conducted in patients with osteopenia–osteoporosis without nephrolithiasis (
n
= 67) in lumbar spine or femur and in a control group (
n
= 61) with no lithiasis or bone disorders. Blood bone markers, phosphocalcic metabolism, fasting urine, 24-h urine lithogenic risk factors, and densitometry were recorded in both groups. SPSS 20.0 was used for statistical analysis.
Results
In comparison with the controls, significantly higher blood calcium (9.27 ± 0.36 vs. 9.57 ± 0.38,
p
= 0.0001), intact parathormone (45.6 ± 14.9 vs. 53.8 ± 18.9,
p
= 0.008), and alkaline phosphatase (61.9 ± 20.9 vs. 70.74 ± 18.9,
p
= 0.014) levels were found in patients with osteopenia–osteoporosis. In the 24-h urine test, citrate (1010.7 ± 647.8 vs. 617.6 ± 315.8,
p
= 0.0001) and oxalate (28.21 ± 17.65 vs. 22.11 ± 16.49,
p
= 0.045) levels were significantly lower in osteopenia–osteoporosis patients than in controls, with no significant difference in calcium (187.3 ± 106.9 vs. 207.06 ± 98.12,
p
= 0.27) or uric acid (540.7 ± 186.2 vs. 511.9 ± 167.06,
p
= 0.35) levels. Patients with osteopenia–osteoporosis had significantly higher levels of lithogenic risk factors associated with bone remodeling, including significantly increased
β
-crosslaps and osteocalcin values and higher
β
-crosslaps/osteocalcin ratios.
Conclusion
Patients with osteopenia–osteoporosis without nephrolithiasis showed phosphocalcic metabolism disorders as well as lower urinary citrate and higher
β
-crosslaps/osteocalcin and fasting calcium/creatinine ratios, which would increase the risk of nephrolithiasis. Hence, prospective studies are warranted to evaluate the long-term risks.
The objective was to evaluate the effect of hydrochlorothiazide and alendronate on urine calcium and bone mineral density in calcium stone-forming patients.
A prospective, non-randomized, ...non-observational comparative study was performed; this study included 111 patients with recurrent calcium stones, divided into 3 groups according to the treatment received. Group 1: 36 patients were treated with alendronate, 70 mg/week; Group 2: 34 patients were treated with alendronate, 70 mg/week + hydrochlorothiazide, 50 mg/day; Group 3: 41 patients were treated with hydrochlorothiazide, 50 mg/day. All patients received recommendations on diet and fluid intake. Other variables of bone mineral density were studied and analyzed, including bone remodeling markers and urinary calcium before and after 2 years of treatment. The statistical analysis was performed using the SPSS 17.0 program, with a statistical significance of p < 0.05.
After 2 years of treatment, a significant difference was observed in the β-crosslaps and a bone mineral density improvement in Group 1, along with a decrease in urinary calcium. In Group 3, a statistically significant difference was found in urinary calcium and fasting calcium/creatinine ratio, as well as an improvement in bone mineral density after 2 years of medical treatment. In Group 2 patients treated with the combination, there was an improvement in bone mineral density and a decrease in the β-crosslaps marker similar to patients in Group 1, and a decrease in urinary calcium similar to those in Group 3.
Combined alendronate + hydrochlorothiazide treatment offers the best results along with the improvement in bone mineral density and decrease in urine calcium in patients with recurrent calcium stones.
Purpose
Recurrent kidney stones are associated with bone mineral density loss, altered bone remodeling markers, hypercalciuria and increased in fasting calcium/creatinine ratio. The objective was to ...determine biochemical alterations in urine in patients with osteopenia/osteoporosis without calcium kidney stones compared with patients with calcium kidney stones.
Methods
This is a cross-sectional study including 142 patients who were divided in two groups: Group 1 (patients with recurrent calcium kidney stones) and Group 2 (patients with osteopenia/osteoporosis in the lumbar spine or hip). Analyses of bone mineral density, calcium–phosphorous and bone metabolism and lithogenic risk factors in fasting urine samples and 24-h urine samples were performed. Statistical analysis was carried out with SPSS 17.0. A
p
≤ 0.05 was considered statistically significant.
Results
Patients in Group 2 presented greater loss of bone mineral density and more elevated alkaline phosphatase, iPTH, phosphorous and β-crosslaps levels, as compared to patients in Group 1. However, Group 1 presented greater urine calcium, oxalate and uric acid and a higher proportion of hypocitraturia, hypercalciuria and hyperoxaluria, as compared to Group 2. Multivariate analysis revealed that advanced age and β-crosslaps levels are risk factors for bone mineral density loss, while low urinary calcium excretion was protective against bone demineralization.
Conclusion
Patients with osteopenia/osteoporosis without lithiasis present some urinary biochemical alterations. This would explain the lack of lithogenic activity, although low calcium excretion in 24-h urine samples is a protective factor against the loss of bone mineral density.
The medium to long-term environmental performances of organic, integrated and conventional olive-growing systems in the average conditions of the south of Spain are evaluated and compared with ...respect to soil erosion, soil fertility, rational use of irrigation water, water contamination, atmospheric pollution and biodiversity, based on experts’ knowledge. The aim of the research was to test the common implicit assumption of environmental superiority of the two alternative farming systems over the conventional system. For this purpose, the Analytic Hierarchy Process (AHP), a widely used multi-criteria decision-making tool, has been implemented. AHP enables us to deal with complex decision-making problems with multiple criteria, stakeholders and decision-makers, high uncertainty and risk, such as in the case of multi-criteria environmental comparison of alternative farming systems. Twenty experts in olive production, clustered into three groups according to their professional field of interest, were involved in the analysis. The utilization of experts' knowledge is justified when information relevant for urgent decision-making is not available, is partial or is time and resource demanding, and a holistic perspective is required. Indexes and procedures are proposed for group decision-making, to detect variation in expert opinions and differences between alternative systems' performances. Despite bias in the judgments of the groups of experts in some topics, results confirm the holistic environmental superiority of organic and integrated alternatives over the conventional olive system in Andalusia in the medium to long-term. The results represent a scientific base to justify and endorse institutional support regarding the promotion and implementation of organic and integrated olive-growing systems in the region, which are likely to result in greater social welfare.
Objective To analyze the effects of aminobisphosphonates and thiazides on renal lithogenic activity and bone mineral density in patients with recurring renal calcium lithiasis. Materials and Methods ...A prospective cohort study with 3 years of clinical follow-up data was performed. The study included 2 groups of patients with recurring calcium lithiasis, hypercalciuria, and bone mineral density loss. Group 1 included 35 patients who underwent treatment with 70 mg/wk alendronate. Group 2 included 35 patients who underwent treatment with 50 mg/d hydrochlothiazide and 70 mg/wk alendronate. Biochemical analysis was performed at baseline, 6 months, and 2 years, bone densitometry at baseline and 2 years, and clinical follow-up during the 3 years of treatment. The biochemical variables from the blood and urine samples, recurrent lithiasis, and bone mineral density were analyzed. Results Age, sex, baseline biochemical markers, and bone density showed no differences between the 2 treatment groups at the onset of treatment. After 2 years of treatment, group 1 showed a significant decrease in bone turnover markers and calciuria and significant improvement in bone mineral density. After 2 years of treatment, group 2 showed a decrease in calciuria and bone markers. At 2 years, the decrease in calciuria and the improvement in bone mineral density were greater in group 2 than in group 1, and the difference was statistically significant. Conclusion Aminobisphosphonates improve bone mineral density and slow lithogenic activity; however, administration of aminobisphosphonates in association with thiazides produced the same clinical effects and also reduced calciuria and improved bone mineral density.
The increase in the demand of analytical tests beside health care costs associated has revealed the need to improve their management in order to reduce the number of unnecessary tests. In our ...emergency laboratory, a protocol has been proposed to remove coagulative fibrinogen determination of the "urgent coagulation profile" when it is unnecessary unless it could be requested by the physician. The aim of the study is to determine the number of pathological fibrinogen results that would justify the realization of this demand management. Retrospective study based on the determination of fibrinogen test (coagulative and calculated, Siemens) and C-Reactive Protein (CRP) (Beckman-Coulter) during a period of six months. Data were obtained using LIS Modulab (WerfenR). Data analysis were performed using regression analysis (Microsoft Excel). Of a total of 21.950 fibrinogen results, 18.235 (83,1%) were processed urgently. 13.345 (73,2%) determinations presented a pathological result (<200 mg/ dL or >350 mg/dL): 4,3% due to a fibrinogen deficiency and 68,9% because of high results. Because one cause of the increase of fibrinogen levels is due to acute phase reactant, the results of the CRP were analyzed, so that 89,7% of high fibrinogen results coincide with values of pathological CRP (>5 mg/L). A good concordance of both coagulative and calculated fibrinogen results was obtained, being the linear regression coefficient R = 0.9324. A high percentage of elevated fibrinogen results is associated with high CRP values, showing that fibrinogen is an acute phase reactant. These results could allow us to exclude the coagulative fibrinogen of the "urgent coagulation profile", decreasing significantly the demand for this test besides a drastic reduction in the laboratory's costs. With the good concordance between fibrinogen methods; coagulative assay could be replaced by calculated fibrinogen in the "urgent coagulation profile", without losing analytical information for physicians.
Study Type – Aetiology (case control)
Level of Evidence 3b
What’s known on the subject? and What does the study add?
Hypercalciuria is related with bone mineral density loss.
This study demonstrates ...the relationship between recurrent calcium nephrolithiasis and bone mineral density loss and their correlation with bone markers.
OBJECTIVES
• To show that a relationship exists between the loss of bone mineral density (BMD) and calcium renal lithiasis and that bone remodelling markers correlate with changes in BMD.
• It is possible that many cases hypercalciuria are related to the increase of bone turnover and the predominance of bone resorption phenomena.
PATIENTS AND METHODS
• The present study comprised a transversal investigation in three groups: group O, without lithiasis; group A, with a single episode of lithiasis; and group B, with relapsed calcium renal lithiasis.
• An analysis was made of body mass index; abdominal X‐ray and/or urography and renal ultrasonography; osteocalcin and β‐crosslaps bone markers; calcium and citrate concentrations in the urine; and femur and spinal column bone densitometry.
• The results were analyzed by analysis of variance and Pearson’s correlation coefficient.
RESULTS
• Patients with relapsed calcium renal lithiasis present a greater BMD loss than those in the O or A groups.
• Densitometry: T‐score femur −0.2 group O, −0.5 group A, −1.2 group B (P= 0.001); T‐score column −0.6 group O, −0.6 group A, −1.3 group B (P= 0.05).
• A statistically significant negative correlation exists between values of β‐crosslaps and T‐score femur (R=−0.251; P= 0.009) and T‐score column (R=−0.324; P= 0.001); thus, a higher concentration of β‐crosslaps was accompanied by a lower value of the T‐score and a greater loss of BMD.
• A positive relationship is observed between β‐crosslaps and osteocalcin (R= 0.611; P < 0.001) and between calciuria and cocient β‐crosslaps/osteocalcin (R= 0.303; P= 0.001).
CONCLUSIONS
• A statistically significant relationship is shown between the loss of BMD and relapsed calcium renal lithiasis.
• Determination of bone remodelling markers (i.e. osteocalcin and β‐crosslaps) facilitates the diagnosis of osteopaenia/osteoporosis in these patients.
