Prevention and treatment of osteoporosis and urolithiasis

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Prevention and treatment of osteoporosis and urolithiasis

Journal Title: Postępy Nauk Medycznych - Year 2012, Vol 25, Issue 3

Abstract

It was suggested that supplementation with calcium and vitamin D, which are essential components of prevention and therapy of osteoporosis, can increase the risk of kidney stone formation. Numerous studies showed, however, that adequate calcium and vitamin D intake reduced the risk of crystallization of both calcium oxalate and calcium phosphate in the urinary tract. In healthy individuals a diet with normal calcium intake of 1000-1300 mg per day is associated with a reduction in kidney stone formation by 30-50% as compared with a diet containing 400-600 mg calcium daily. Higher dietary calcium intake results in binding of oxalate in the gut, diminished oxalate absorption from the intestine and reduced urinary oxalate excretion. It was shown that additional calcium supplementation was not associated with increased risk of kidney stones unless calcium is taken apart from meals and total calcium intake exceeds 2000 mg per day. In patients with an absorptive hypercalciuria the rise in urinary calcium may overhelm benefits subsequent to a reduction in urinary oxalate. Any restriction in dietary calcium in these patients may result, however, in a decrease in BMD and increased risk of bone fractures. It was suggested that adequate calcium intake should be provided together with high fluid intake and a diet with moderate amounts of protein, small amounts of sodium and rich in potassium and magnesium. Thiazides in combination with potassium supplement as well as high doses of vitamin B&lt;sub&gt;6&lt;/sub&gt; are the therapeutic alternatives. &lt;br&gt;Supplementation with vitamin D at the doses used in the prevention and treatment of osteoporosis should be regarded as safe. It was shown that vitamin D in the doses of up to 10,000 IU per day given over several months did not result in hypercalcemia, hypercalciuria and kidney stone formation. No cases of confirmed intoxication with vitamin D have been reported if serum 25OHD concentrations were below 200 ng/ml. Doses of vitamin D needed to produce such levels are in excess of 20,000 IU daily.&lt;br&gt;It should be stressed that the duration of vitamin D exposure in many clinical trials could be too short to form urinary stones. It was suggested that vitamin D intoxication occurs only if vitamin D&lt;sub&gt;2&lt;/sub&gt; or D&lt;sub&gt;3&lt;/sub&gt; is given for several years at the dose of at least 10,000 IU daily. In most reports hypercalcemia and hypercalciuria were not accompanied by urinary stones.

Authors and Affiliations

Marek Tałałaj, Marta Toboła

Keywords

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EP ID EP54422
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