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Dietary modifications alone do not improve bone mineral density in children with idiopathic hypercalciuria

A.L. Schwaderer, T. Srivastava, L. Schueller, R. Cronin, J.D. Mahan and D. Hains

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Volume 76 (2011) p. 341 - 347

Abstract

Dietary modifications alone do not improve bone mineral density in children with idiopathic hypercalciuria

A.L. Schwaderer¹, T. Srivastava², L. Schueller³, R. Cronin⁴, J.D. Mahan¹ and D. Hains¹

¹The Ohio State University College of Medicine/Nationwide Children’s Hospital, Department of Pediatrics, Division of Pediatric Nephrology, Columbus, OH, ²Bone and Mineral Disorder Clinic, The Children’s Mercy Hospital and Clinics, University of Missouri, Kansas City, MO, ³The Research Institute at Nationwide Children’s Hospital, and ⁴The Ohio State University College of Medicine, Columbus, OH, USA
Prior cross-sectional studies have demonstrated an association between hypercalciuria and low bone mineral density (BMD) in children and adults. However, the natural history of BMD in children with hypercalciuria and its response to therapy has not been evaluated. The objective of this retrospective study was to determine the change over time in lumbar (L1 – L4) BMD Z-score measured on sequential DXA scans in 19 children with hypercalciuria treated with dietary recommendations without (n = 12, Group A) and with citrate (n = 7, Group B). The mean lumbar bone density Z-score/year decreased in Group A (–0.11 ±/0.41) indicating that children with hypercalciuria lose L1 – L4 BMD over time. In contrast, the L1 – L4 BMD Zscore/ year increased in Group B (0.19 ± 0.38) suggesting that pharmacologic therapy may reverse this trend. Similarly 75% of patients in Group A, but only 29% patients in Group B had a decrease in L1 – L4 BMD. There was a definite, although not significant, trend towards improved mean bone mineral density Z-score per year and a lower percentage of patients with a decreased Z-score in hypercalciuric children treated with potassium citrate. Our findings suggest the possibility that dietary recommendations alone is not adequate as the bone mineral density of children with hypercalciuria will decrease over time, potentially increasing the risk for osteoporosis as an adult.Correspondence to:
Dr. A.L. Schwaderer
700 Children’s Drive
Columbus, OH 43205, USA
Email: [email protected]

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