Nephrolithiasis, bone mineral density, osteoporosis, and fractures: a systematic review and comparative meta-analysis.
Our meta-analysis demonstrates that people with nephrolithiasis have decreased bone mineral density, an increased odds of osteoporosis, and potentially an elevated risk of fractures.



People with nephrolithiasis might be at risk of reduced bone mineral density (BMD) and fractures, but the data is equivocal. We conducted a meta-analysis to investigate if patients with nephrolithiasis have worse bone health outcomes (BMD), osteoporosis, and fractures versus healthy controls (HCs).



Two investigators searched major databases for articles reporting BMD (expressed as g/cm2or a T- or Z-score), osteoporosis or fractures in a sample of people with nephrolithiasis, and HCs. Standardized mean differences (SMDs), 95 % confidence intervals (CIs) were calculated for BMD parameters; in addition odds (ORs) for case-control and adjusted hazard ratios (HRs) in longitudinal studies for categorical variables were calculated.



From 1816 initial hits, 28 studies were included. A meta-analysis of case-control studies including 1595 patients with nephrolithiasis (mean age 41.1 years) versus 3402 HCs (mean age 40.2 years) was conducted. Patients with nephrolithiasis showed significant lower T-scores values for the spine (seven studies; SMD = -0.69; 95 % CI = -0.86 to -0.52; I2= 0 %), total hip (seven studies; SMD = -0.82; 95 % CI = -1.11 to -0.52; I2= 72 %), and femoral neck (six studies; SMD = -0.67; 95 % CI = --1.00 to -0.34; I2= 69 %). A meta-analysis of the case-controlled studies suggests that people with nephrolithiasis are at increased risk of fractures (OR = 1.15, 95 % CI = 1.12-1.17, p < 0.0001, studies = 4), while the risk of fractures in two longitudinal studies demonstrated trend level significance (HR = 1.31, 95 % CI = 0.95-1.62). People with nephrolithiasis were four times more likely to have osteoporosis than HCs (OR = 4.12, p < 0.0001).



Nephrolithiasis is associated with lower BMD, an increased risk of osteoporosis, and possibly, fractures. Future screening/preventative interventions targeting bone health might be indicated.
Department of Medicine - DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
P
P
Lucato
Department of Medicine - DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
C
C
Trevisan
Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.|Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, Box, SE5 8 AF, London, UK.
B
B
Stubbs
Department of Medicine - DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
B M
BM
Zanforlini
Department of Neurosciences, University of Padova, Padova, Italy.|Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy.
M
M
Solmi
Department of Pathology and Diagnostics, Verona University and Hospital Trust, Verona, Italy.|Azienda Provinciale per i Servizi Sanitari (APSS) Trento, Trento, Italy.
C
C
Luchini
Department of Medicine - DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
G
G
Girotti
Department of Medicine - DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
S
S
Pizzato
Department of Medicine - DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.|National Research Council, Aging Branch, Institute of Neuroscience, Padova, Italy.
E
E
Manzato
Department of Medicine - DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
G
G
Sergi
Department of Medicine, Clinica Medica I, University of Padova, Padova, Italy.
S
S
Giannini
National Research Council (CNR), Neuroscience Institute, Padova, Italy.
M
M
Fusaro
Department of Medicine - DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy. ilmannato@gmail.com.|Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy. ilmannato@gmail.com.
N
N
Veronese
D000328:Adult; D015519:Bone Density; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D053040:Nephrolithiasis / Q000150:complications*; D010024:Osteoporosis / Q000150:complications*; D012307:Risk Factors
Bone mineral density; Fractures; Kidney stone; Nephrolithiasis; Osteoporosis