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NDT Advance Access published online on April 8, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn091
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.For Permissions, please e-mail: journals.permissions@oxfordjournals.org


PTH and 1.25 vitamin D response to a low-calcium diet is associated with bone mineral density in renal stone formers

Andreas Pasch, Felix J. Frey, Ute Eisenberger, Markus G. Mohaupt and Olivier Bonny

Department of Nephrology and Hypertension, Inselspital, University of Bern, Switzerland

Correspondence and offprint requests to: Andreas Pasch, Department of Nephrology and Hypertension, Inselspital, University of Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland. E-mail: andreas.pasch{at}insel.ch



  Abstract

Background. Renal calcium stones and hypercalciuria are associated with a reduced bone mineral density (BMD). Therefore, the effect of changes in calcium homeostasis is of interest for both stones and bones. We hypothesized that the response of calciuria, parathyroid hormone (PTH) and 1.25 vitamin D to changes in dietary calcium might be related to BMD.

Methods. A single-centre prospective interventional study of 94 hyper- and non-hypercalciuric calcium stone formers consecutively retrieved from our stone clinic. The patients were investigated on a free-choice diet, a low-calcium diet, while fasting and after an oral calcium load. Patient groups were defined according to lumbar BMD (z-score) obtained by dual X-ray absorptiometry (group 1: z-score <–0.5, n = 30; group 2: z-score –0.5–0.5, n = 36; group 3: z-score >0.5, n = 28). The effect of the dietary interventions on calciuria, 1.25 vitamin D and PTH in relation to BMD was measured.

Results. An inverse relationship between BMD and calciuria was observed on all four calcium intakes (P = 0.009). On a free-choice diet, 1.25 vitamin D and PTH levels were identical in the three patient groups. However, the relative responses of 1.25 vitamin D and PTH to the low-calcium diet were opposite in the three groups with the highest increase of 1.25 vitamin D in group 1 and the lowest in group 3, whereas PTH increase was most pronounced in group 3 and least in group 1.

Conclusion. Calcium stone formers with a low lumbar BMD exhibit a blunted response of PTH release and an apparently overshooting production of 1.25 vitamin D following a low-calcium diet.

Keywords: 1.25 vitamin D; bone mineral density; hypercalciuria; nephrolithiasis; parathyroid hormone

Received for publication: 3. 7.07
Accepted in revised form: 30. 1.08


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