Nephrolithiasis-associated bone disease: pathogenesis and treatment options

Kidney Int. 2011 Feb;79(4):393-403. doi: 10.1038/ki.2010.473. Epub 2010 Dec 1.


Nephrolithiasis remains a formidable health problem in the United States and worldwide. A very important but underaddressed area in nephrolithiasis is the accompanying bone disease. Epidemiologic studies have shown that osteoporotic fractures occur more frequently in patients with nephrolithiasis than in the general population. Decreased bone mineral density and defects in bone remodeling are commonly encountered in patients with calcium nephrolithiasis. The pathophysiologic connection of bone defects to kidney stones is unknown. Hypercalciuria and hypocitraturia are two important risk factors for stone disease, and treatments with thiazide diuretics and alkali, respectively, have been shown to be useful in preventing stone recurrence in small prospective trials. However, no studies have examined the efficacy of these agents or other therapies in preventing continued bone loss in calcium stone formers. This manuscript reviews the epidemiology, pathophysiology, and potential treatments of bone disease in patients with nephrolithiasis.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Anabolic Agents / therapeutic use
  • Bone Density
  • Bone Density Conservation Agents / therapeutic use
  • Bone Remodeling / physiology
  • Calcium, Dietary / administration & dosage
  • Cytokines / physiology
  • Female
  • Genetic Predisposition to Disease
  • Hormones / physiology
  • Humans
  • Male
  • Nephrolithiasis / complications*
  • Nephrolithiasis / physiopathology
  • Osteoporosis / etiology*
  • Osteoporosis / physiopathology
  • Osteoporosis / therapy*
  • Potassium Citrate / therapeutic use
  • Risk Factors
  • Sodium Chloride Symporter Inhibitors / therapeutic use
  • Vitamin D / administration & dosage


  • Anabolic Agents
  • Bone Density Conservation Agents
  • Calcium, Dietary
  • Cytokines
  • Hormones
  • Sodium Chloride Symporter Inhibitors
  • Vitamin D
  • Potassium Citrate