Urolithiasis and osteoporosis: clinical relevance and therapeutic implications

Abstract

Nekoliko kliničkih i epidemioloških istraživanja otkrila su povećanu koštanu pregradnju i nižu koštanu masu u bolesnika s urolitijazom. Gubitak koštane mase posebno je uočen kod idiopatske kalcijske urolitijaze. Međutim, patogenetski mehanizmi i čimbenici povezani s gubitkom koštane mase u ovih bolesnika su još uvijek nepoznati. Ograničenje kalcija u prehrani, povećani unos soli i životinjskih proteina, polimorfizam receptora za vitamin D su vjerojatni rizični čimbenici. Uloge proupalnih citokina, osteopontina i prostaglandinom posredovane resorpcije kostiju još treba istražiti. Dokazano je da pozitivan utjecaj u prevenciji i liječenju osteoporoze i urolitijaze imaju nadomjesci kalcija i prehrana s povećanim unosom kalcija s kalijevim alkalijama. Tiazidski diuretici smanjuju hiperkalciriju u bubrežnim tubulima, te dodatno promoviraju diferencijaciju osteoblasta. Konačno, bisfosfonati, uobičajena terapija osteoporoze, imaju potencijal za inhibiciju stvaranja kalcijskih kamenaca, dok se pozitivan učinak antioksidansa treba još detaljno istražiti.Several clinical and epidemiological studies revealed increased bone turnover and lower bone mass in patients with urolithiasis. Bone mass loss is particularly evident in idiopathic calcium stone formers. However, pathogenetic mechanisms and factors implicated in bone loss in these patients are still unknown. Dietary calcium restriction, increased intake of salt and animal proteins, vitamin D receptor polymorphisms are likely risk factors, while role of inflammatory cytokines, osteopontin and prostaglandin mediated bone resorption is yet to be determined. Regarding treatment and prevention, it has been proven that calcium supplements and high calcium diet with the addition ot potassium alkali have an important role in prevention and treatment of both, urolithiasis and osteoporosis. Thiazide diuretics reduce hypercalciuria in renal tubules, and in addition promote osteoblast differentiation. Finally, bisphosphonates, a commonly used drugs in treatment of osteoporosis, show the potential to inhibit calcium stone formation, whereas a possible protective effect of antioxidants in bone loss and renal injury needs to be investigated further