Tsuji Hidenori, Umekawa Tohru, Kurita Takashi, Uemura Hirotsugu, Iguchi Masanori, Kin Kokai, Kushida Kazuhiro
Department of Urology, Kinki University School of Medicine, Ohnohigashi Osakasayama Osaka, Japan.
Int J Urol. 2005 Apr;12(4):335-9. doi: 10.1111/j.1442-2042.2005.01049.x.
The association between hypercalciuria and bone mineral density (BMD) has been already recognized. The aim of the present study is to relate BMD to age and sex and to evaluate the calcium metabolism and hypercalciuria-defined dietary or non-dietary category in patients with urolithiasis.
The BMI of the L2-L4 lumbar vertebrae was measured in 310 renal stone patients (191 men and 119 women). Percent age matched score (%AMS), which is the percent ratio of measured BMD to the mean BMD of age-matched control subjects, was utilized for the appraisal of BMD. Low BMD groups were defined by lower than 90% of %AMS.
Low BMD was observed in 27.7% of urinary stone patients, which was not a significant difference to that of control subjects (23.5%) who were measured in the health examination. In male patients with urolithiasis, the frequency of patients in whom BMD had been apt to decrease since youth was high, but there was not a proven significant difference among the three age groups (20-39 years old, 40-59 years old and 60 years old or older). In contrast, for female stone patients, the frequency of low BMD markedly increased in patients aged 40 years or older, when menopause occurs. Furthermore, in female stone patients with hypercalciuria, the frequency of reduced BMD reached more than 40%. When the cause was non-dietary hypercalciuria (classified mainly on the daily amount of urinary calcium excretion after ingestion of calculus test diet), the frequency of reduced BMD reached 65% (P < 0.01).
In case female stone patients with non-dietary hypercalciuria become menopausal, not only the risk of recurrent lithiasis increases, but the possibility of developing osteopenia in the future also increases. Appropriate treatments for prophylactic effects on urolithiasis or osteopenia should be considered, as judged from BMD, diet, sex, urinary calcium excretion and other factors synthetically.
高钙尿症与骨密度（BMD）之间的关联已得到认可。本研究的目的是将骨密度与年龄和性别相关联，并评估尿路结石患者的钙代谢以及由高钙尿症定义的饮食或非饮食类别。
测量了310例肾结石患者（191例男性和119例女性）L2 - L4腰椎的骨密度。年龄匹配百分比评分（%AMS），即测量的骨密度与年龄匹配对照受试者平均骨密度的百分比，用于评估骨密度。低骨密度组定义为低于%AMS的90%。
在尿路结石患者中，27.7%观察到低骨密度，这与健康检查中测量的对照受试者（23.5%）无显著差异。在男性尿路结石患者中，自年轻时起骨密度易于降低的患者频率较高，但在三个年龄组（20 - 39岁、40 - 59岁和60岁及以上）之间没有经证实的显著差异。相比之下，对于女性结石患者，在40岁及以上绝经时发生的患者中，低骨密度的频率显著增加。此外，在高钙尿症的女性结石患者中，骨密度降低的频率达到40%以上。当病因是非饮食性高钙尿症（主要根据摄入结石试验饮食后每日尿钙排泄量分类）时，骨密度降低的频率达到65%（P < 0.01）。
对于非饮食性高钙尿症的女性结石患者，进入绝经期后，不仅复发性结石的风险增加，而且未来发生骨质减少的可能性也增加。应综合考虑骨密度、饮食、性别、尿钙排泄等因素，考虑采取适当的治疗措施预防尿路结石或骨质减少。
