Jonathan Hong BS Niccolo Passoni MD Angelena Edwards MD Joseph Crivelli MD Irina Stanasel MD Jyothsna Gattineni MD Elizabeth Brown MD Naim Maalouf MD ID: 1046394
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1. Hyperoxaluria in Pediatric Stone Formers is Associated with Decreased Bone Density Jonathan Hong, BS; Niccolo Passoni, MD; Angelena Edwards, MD; Joseph Crivelli, MD; Irina Stanasel, MD; Jyothsna Gattineni, MD; Elizabeth Brown, MD; Naim Maalouf, MD; Khashayar Sakhaee, MD; Craig Peters, MD; Linda A. Baker, MD.
2. BackgroundPediatric Nephrolithiasis Low Bone Density Increased Fracture Risk/OsteoporosisSTUDY QUESTION: Are there other 24hr urine stone risk profile abnormalities associated with low bone density in an otherwise healthy cohort of pediatric stone formers?Hypercalciuria explains 45.6% of low bone density in children with stones
3. MethodologyData Sets: Stone database: IRB-approved retrospective database search for cohort of newly diagnosed nephrolithiasis patients ≤18 at Children’s Health from 2000 – 2019. During this time frame, all patients were scheduled for DXA and 24hr urine stone risk profile (24hSRP) testing.DXA database: BMD Z-score downloaded from the Institutional Hologic DXA machine (from 2000-2019).Hologic DXA scans were matched with stone database.Exclusion criteria: Medically Complex, Absent DXA or 24hrSRPDefinitions:Medically complex vs. Non-medically complexLow Bone Density is Z-score < -2 (lowest of imaged sites: forearm, L spine, or hip)Standard pediatric definitions were used for 24hrSRP abnormalitiesStatistics: Z-score distributions were compared by Chi-square test for gender and ethnicity24HrSRP values were compared using Chi-square test and Pearson’s coefficient Examples of medically-complex diagnosisCystinuriaNeurogenic bladderUPJOLupusEhlers-Danlos syndromeB-ALL
4. Results1039 pediatric stone formers <19 yoNon-medically complex stone formers:453Patients with DXA scan282Excluded because medically complex: -586Excluded because no DXA: -17124Hr SRP available in 98 of 282 patients:Low BMD: 11Normal BMD: 87
5. Results – Bone Density Z-score Distribution (n=282)
6. Results – Bone Density Z-score Distribution (n=282)Median: -0.7IQR: -1.3 – 0.1
7. Results – Bone Density Z-score Distribution (n=282)Z-score -2Median: -0.7IQR: -1.3 – 0.1
8. Results – Bone Density Z-score Distribution (n=282)Z-score -2Percent of normal patients with a Z-score <-2:2.275%
9. Results – Bone Density Z-score Distribution (n=282)Z-score -2Percent of healthy stone formers with a Z-score <-2:10.6%
10. Bone Density Z-Score Stratified by Gender and RacePercentage of low BMD:Normal: 2.275%Male: 12.1% Female: 9.5%P=0.5Percentage of low BMD:Normal: 2.275%Non-Hispanic: 11.1%Hispanic: 9.1%P=0.6Z-score by GenderZ-score by Ethnicity
11. 24-Hour Stone Risk ProfileOverall (N=98)Bone density Z-score > -2 (N=87)Bone density Z-score ≤ -2 (N=11)p value Volume (L)(median, IQR)1.0 (0.6, 1.4)1.0 (0.6, 1.5)0.9 (0.7, 1.3)0.6pH (median, IQR)6.42 (6.13, 6.76)6.42 (6.11, 6.76)6.42 (6.27, 6.65)0.8Hypercalciuria ( Ca24/Kg > 4)36 (37%) 30 (35%)6 (55%)0.2 Hypocitraturia (Cit24/Cr24 <130 if male or <300 if female)18 (19%) 16 (19%)2 (18%)1 Hyperoxaluria (Ox24/1.73 m2>50)13 (13%) 9 (10%)4 (36%)0.02
12. Study LimitationsRetrospective studyLack of data on medical management and its relation to timing of DXA scan and dietary history Non-standardized metabolic testing (24hr stone risk profile)
13. ConclusionsOtherwise healthy pediatric stone formers are 5 times more likely to have low bone density (DXA z-score < -2) than general populationComparing healthy pediatric stone formers with low vs. normal BMD:Frequency of hyperoxaluria was significantly higherHypercalciuria was not significantly more frequent