title: High sodium chloride intake is associated with low bone density in calcium stone-forming patients.
abstract: BACKGROUND
  Although renal stone disease has been associated with reduced bone mass, the impact of nutrient intake on bone loss is unknown.
  
  
  METHODS
  The present study was undertaken to investigate the influence of nutrient intake on bone density of 85 calcium stone-forming (CSF) patients (47 male and 38 premenopausal females) aged 41+/-11 years (X+/-SD). Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry at the lumbar spine (L2-L4) and femoral neck sites, and low BMD was defined as a T score < -1 (WHO criteria). A 4-day dietary record and a 24-hour urine sample were obtained from each patient for the assessment of nutrient intake and urinary calcium (U(Ca)), sodium (U(Na)), phosphate and creatinine excretion.
  
  
  RESULTS
  Forty-eight patients (56%) presented normal BMD and 37 (44%) low BMD. There were no statistical differences regarding age, weight, height, body mass index, protein, calcium and phosphorus intakes between both groups. The mean U(Ca), phosphorus and nitrogen appearance also did not differ between groups. However, there was a higher percentage of hypercalciuria among low vs normal BMD patients (62 vs 33%, p < 0.05). Low BMD patients presented a higher mean sodium chloride (NaCl) intake and excretion (UNa) than normal BMD (14+/-5 vs 12+/-4 g/day and 246+/-85 vs 204+/-68 mEq/day, respectively p < 0.05). The percentage of patients presenting NaCl intake > or = 16 g/day was also higher among low vs normal BMD patients (35 vs 12%, p < 0.05). After adjustment for calcium and protein intakes, age, weight, body mass index, urinary calcium, citrate and uric acid excretion, and duration of stone disease, multiple-regression analysis showed that a high NaCl intake (> or = 16 g/day) was the single variable that was predictive of risk of low bone density in CSF patients (odds ratio = 3.8).
  
  
  CONCLUSIONS
  These data suggest that reducing salt intake should be recommended for CSF patients presenting hypercalciuria and osteopenia.
authors.affiliation: Nephrology Division, Universidade Federal de São Paulo, EPM, Brasil.
authors.forename: L A
authors.initials: LA
authors.lastname: Martini
authors.forename: L
authors.initials: L
authors.lastname: Cuppari
authors.forename: F A
authors.initials: FA
authors.lastname: Colugnati
authors.forename: D M
authors.initials: DM
authors.lastname: Sigulem
authors.forename: V L
authors.initials: VL
authors.lastname: Szejnfeld
authors.forename: N
authors.initials: N
authors.lastname: Schor
authors.forename: I P
authors.initials: IP
authors.lastname: Heilberg
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D015519:Bone Density; D002136:Calcium, Dietary / Q000008:administration & dosage; D015930:Diet Records; D004044:Dietary Proteins / Q000008:administration & dosage; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging; D006801:Humans; D007669:Kidney Calculi / Q000737:chemistry / Q000209:etiology / Q000378:metabolism*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D016226:Phosphorus, Dietary / Q000008:administration & dosage; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage*
chemical_list: D002136:Calcium, Dietary; D004044:Dietary Proteins; D016226:Phosphorus, Dietary; D017673:Sodium Chloride, Dietary