Rapid Hypercalciuria Induction With Bone Formation Marker Reduction During Immobilization in Children

Endocr Pract. 2021 Oct;27(10):998-1003. doi: 10.1016/j.eprac.2021.05.009. Epub 2021 Jun 5.


Objective: To prospectively examine the occurrence of hypercalciuria and changes in bone metabolite markers in pediatric patients during immobilization.

Methods: In total, 13 children with an orthopedic disease requiring immobilization longer than 2 weeks were enrolled. Blood samples were collected after breakfast. Urine samples were collected at the second voiding after waking. The urine calcium/creatinine (Ca/Cr) ratio and various bone metabolite parameters were measured before and every 1 to 4 weeks after the start of immobilization.

Results: The median patient age was 7 years with a range of 2 to 13 years. Orthopedic diseases in the patients were dislocated hip joint (N = 7), slipped capital femoral epiphysis (N = 2), etc. The urine Ca/Cr ratio increased significantly within a week after immobilization (P < .01) and continued to increase for 2 more weeks. Once immobilization ended, the urine Ca/Cr ratio gradually decreased and returned to the normal range approximately 6 weeks after mobility was achieved (P < .01). Serum alkaline phosphatase (ALP) and bone-specific ALP significantly decreased after immobilization began (P < .01). After immobilization ended, the serum ALP returned to preimmobilization levels in 2 to 4 weeks (P < .01). Serum N-terminal telopeptides did not change significantly during immobilization.

Conclusion: The urine Ca/Cr ratio immediately increased after immobilization. In contrast to adults, bone formation markers in children decreased during immobilization, whereas bone resorption markers did not increase. To our knowledge, this study is the first to examine bone metabolism markers in children during immobilization.

Keywords: bone metabolism; child; hypercalciuria; immobilization.

MeSH terms

  • Adolescent
  • Adult
  • Biomarkers
  • Bone and Bones
  • Calcium
  • Child
  • Child, Preschool
  • Humans
  • Hypercalciuria* / epidemiology
  • Osteogenesis*


  • Biomarkers
  • Calcium