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Idiopathic Osteoporosis and Nephrolithiasis: Two Sides of the Same Coin?

Domenico Rendina 1Gianpaolo De Filippo 2 3Gabriella Iannuzzo 1Veronica Abate 1Pasquale Strazzullo 1Alberto Falchetti 4 5

Int J Mol Sci doi: 10.3390/ijms21218183.

Abstract

Idiopathic osteoporosis and nephrolithiasis are formidable health problems showing a progressive increase in their incidence and prevalence in the last decades. These temporal trends were observed in both pediatric and adult populations worldwide. Epidemiological and experimental studies indicate that both disorders show several common pathogenic environmental and genetic factors. In this review, we analyzed the clinical characteristics common to the two disorders and the state-of-the-art knowledge regarding the genetic predisposition and the environmental factors recognized as triggers in adult and pediatric ages. As a result of this work, we propose to consider idiopathic nephrolithiasis and osteoporosis as two possible expressions of a unique clinical syndrome. Accordingly, the clinical approach to both disorders should be modified in order to program an efficient primary and secondary prevention strategy.

Conclusions

As reported in previous sections, the bulk of epidemiological and experimental data support a statistical association between idiopathic nephrolithiasis and osteoporosis, two disorders sharing many similarities with regard to environmental and genetic background. Based on such evidence, we propose to consider idiopathic nephrolithiasis and osteoporosis as the possible expressions of a unique clinical syndrome. This view involves a holistic approach to the clinical management of patients with nephrolithiasis or osteoporosis and suggests the need to evaluate the consensual occurrence of either disorder in all a_ected patients. On practical grounds, this holistic approach involves the assessment of metabolic risk factors for nephrolithiasis (by the measurement of 24-h urinary excretion of calcium, phosphate, citrate, magnesium and urate) in patients with osteoporosis and, conversely, the evaluation of the bone mineral density by dual-energy X-ray absorptiometry in patients with a personal history of nephrolithiasis. In osteoporotic patients, an ultrasound examination of the abdomen should be also performed after the diagnosis of osteoporosis to evaluate the occurrence of kidney stones. This approach would guarantee the optimal treatment of most patients with either type of metabolic disorder. To this end, the development of a specific public health strategy is definitely warranted.