Risk factors for the comorbidity of osteoporosis/osteopenia and kidney stones: a cross-sectional study

The association between the presence of kidney stones and the risk of developing osteoporosis: a NHANES-based cross-sectional study and Mendelian randomization analysis

PURPOSE

To investigate whether the presence of kidney stones increases the risk of developing osteoporosis.

METHODS

First, we performed an observational study on the basis of data from the National Health and Nutrition Examination Survey (NHANES; 2007-2020). Kidney stone patients were identified on the basis of their affirmative response to the question "Have you ever experienced kidney stones?" (KIQ026). Participants whose T score at the femoral neck was < -2.5 were defined as osteoporosis patients. Multivariable-adjusted logistic regression was used to assess the correlation between the presence of kidney stones and the risk of developing osteoporosis. Second, Mendelian randomization (MR) was applied to further investigate the causal relationship between the presence of kidney stones and the risk of developing osteoporosis. Genetic instruments were obtained from large genome-wide association studies (GWASs) from the UK Biobank and FinnGen Biobank. Inverse-variance weighting (IVW) was the primary analytical method used.

RESULTS

After adjustment for demographic and other covariates, a significant association between the presence of kidney stones and the risk of developing osteoporosis was detected (OR 1.778, CI: 1.345-2.351, P < 0.001). The MR results further revealed that genetically speaking, the presence of kidney stones was causally associated with a greater risk of developing osteoporosis (IVW: OR 1.088, CI: 1.015-1.167, P < 0.05).

CONCLUSION

The presence of kidney stones is associated with an increased risk of developing osteoporosis. Further prospective cohort studies are needed to validate our results.

Bone mineral density and sex hormone binding globulin as potential mediators of the causal effect of urolithiasis on osteoporosis risk: a Mendelian randomization

Objective

Osteoporosis (OP) and urolithiasis (UL) are two metabolic diseases that are prevalent globally. Previous observational studies have found a relationship between these two diseases that increases the risk of each other, but whether there is a direct causal link is still unclear. Currently, research on the mechanisms of these two diseases mainly focuses on external factors such as diet and environment. Thus, this study used two-sample mendelian randomization (TS-MR) in conjunction with mediation analysis to explore the causal relationship between OP and UL and their potential mechanisms. Mediators included total body bone mineral density (T-BMD), sex hormone binding globulin (SHBG), serum 25-hydroxyvitamin D (serum 25(OH)D) levels, and calcium supplements.

Method

We acquired UL-related and BMD-related single nucleotide polymorphisms (SNPs) from the MRC IEU Open Genome-Wide Association Study (GWAS) database. The primary SNPs data of osteoporosis were from the FinnGen database. To clarify the mediators involved in the link between OP and UL, we performed a MR investigation. The primary approach to analysis was inverse variance weighting (IVW). In addition, we also used another osteoporosis data from UK biobank (UKB) to further verify the mediating role.

Results

We discovered that there was a 14% increase in the incidence of OP in UL patients using the IVW approach. (FinnGen: OR = 1.1491,95% CI: 1.0544-1.2523; UKB: OR = 1.1339,95% CI: 1.0266-1.2523). Among different age groups, except for the 15-45 age group, we observed that UL increased the risk of low bone mineral density. Similarly, consistent results were also observed in bone mineral density at different sites. Mediation analysis showed that 50% of the effect of UL on OP was mediated by BMD levels (FinnGen:49.68%; UKB:56.45%). In addition, we also observed an important mediating effect between sex hormone binding globulin (SHBG) on UL and an increased risk of OP, but with a lower proportion of mediators (FinnGen:2.406%; UKB:2.595%). Furthermore, we also found decreased serum 25 (OH) D levels in UL patients, but not its mediating effect.

Conclusions

In conclusion, the study establishes a direct causal link between urolithiasis and OP, independent of environmental factors. Furthermore, mediation analysis showed that bone density and SHBG levels partially mediated the risk of OP in UL patients, suggesting that both mediators may be involved in the mechanism of UL-induced OP. These findings broaden the understanding of the link between the UL and the OP. Thus, regardless of lifestyle, urolithiasis patients should remain vigilant about the risk of OP and consider regular OP screening.

Plasma proteome fingerprint in kidney diseases

Introduction

Kidney diseases pose a serious healthcare problem because of their high prevalence, worsening of patients' quality of life, and high mortality. Patients with kidney diseases are often asymptomatic until disease progression starts. Expensive renal replacement therapy options, such as dialysis or kidney transplant, are required for end-stage kidney disease. Early diagnosis of kidney pathology is crucial for slowing down or curbing further damage. This study aimed to analyze the features of the protein composition of blood plasma in patients with the most common kidney pathologies: kidney calculus, kidney cyst, and kidney cancer.

Methods

The study involved 75 subjects. Proteins associated with kidney pathologies (CFB, SERPINA3, HPX, HRG, SERPING1, HBB, ORM2, and CP) were proposed. These proteins are important participants of complement and coagulation cascade activation and lipid metabolism.

Results

The revealed phosphorylated proteoforms (CFB, C4A/C4B, F2, APOB, TTR, and NRAP) were identified. For them, modification sites were mapped on 3D protein models, and the potential role in formation of complexes with native partner proteins was assessed.

Discussion

The study demonstrates that the selected kidney pathologies have a similar proteomic profile, and patients can be classified into kidney pathology groups with an accuracy of (70-80)%.

Association between cardiometabolic index and kidney stone from NHANES: a population-based study

Purpose

The Cardiometabolic Index (CMI) is a novel marker of visceral obesity and dyslipidemia. Our study aimed to explore the association between CMI and kidney stones among US adults.

Methods

This cross-sectional study was conducted among adults with complete records of CMI and kidney stones information from the 2011 to 2018 National Health and Nutrition Examination Survey (NHANES). Inverse probability treatment weighting (IPTW) was used to balance the baseline characteristics of the study population. The independent relationship between CMI and kidney stones was evaluated using IPTW-adjusted multivariate logistic regression, restricted cubic splines (RCS), and subgroup analysis.

Results

A total of 9,177 participants, with an average CMI of 0.72 (0.99), were included in this study. The IPTW-adjusted logistic regression revealed that CMI was an independent risk factor for kidney stones. The adjusted odds ratio (OR) for kidney stones were 1.39 (95% CI: 1.24 - 1.56, P < 0.001) for the second CMI tertile and 1.31 (95% CI: 1.17 - 1.47, P < 0.001) for the third CMI tertile, compared with the first CMI tertile. A linear relationship between CMI levels and kidney stone risk was observed in the RCS analysis. Subgroup analysis showed that the association between CMI levels and kidney stone risk remained stable across groups.

Conclusions

A positive association between CMI level and the risk of kidney stones was observed among US adults in our study. Further large-scale prospective studies are needed to validate our findings.

A high-calcium environment induced ectopic calcification of renal interstitial fibroblasts via TFPI-2-DCHS1-ALP/ENPP1 axis to participate in Randall's plaque formation

Randall's plaques (RP) serve as anchoring sites for calcium oxalate (CaOx) stones, but the underlying mechanism remains unclear. Renal interstitium with a high-calcium environment is identified as pathogenesis of RP formation where the role of human renal interstitial fibroblasts (hRIFs) was highlighted. Our study aims to elucidate the potential mechanism by which a high-calcium environment drives ectopic calcification of hRIFs to participate in RP formation. Alizarin Red staining demonstrated calcium nodules in hRIFs treated with high-calcium medium. Utilizing transcriptome sequencing, tissue factor pathway inhibitor-2 (TFPI-2) was found to be upregulated in high-calcium-induced hRIFs and RP tissues, and TFPI-2 promoted high-calcium-induced calcification of hRIFs. Subsequently, the downstream regulator of TFPI2 was screened by transcriptome sequencing analysis of hRIFs with TFPI-2 knockdown or overexpressed. Dachsous Cadherin Related 1 (DCHS1) knockdown was identified to suppress the calcification of hRIFs enhanced by TFPI-2. Further investigation revealed that TFPI-2/DCHS1 axis promoted high-calcium-induced calcification of hRIFs via disturbing the balance of ENPP1/ALP activities, but without effect on the canonical osteogenic markers, such as osteopontin (OPN), osteogenic factors runt-related transcription factor 2 (RUNX2), bone morphogenetic protein 2 (BMP2). In summary, our study mimicked the high-calcium environment observed in CaOx stone patients with hypercalciuria, and discovered that the high-calcium drove ectopic calcification of hRIFs via a novel TFPI-2-DCHS1-ALP/ENPP1 pathway rather than adaption of osteogenic phenotypes to participate in RP formation.

Inquiry of the Metabolic Traits in Relationship with Daily Magnesium Intake: Focus on Type 2 Diabetic Population

Magnesium (Mg), an essential nutrient with a wide area of physiological roles, stands as a cofactor in over 600 enzymatic reactions involved in the synthesis of proteins and nucleic acids, DNA repair, neuromuscular functions, neuronal transmission, cardiac rhythm regulation, and the modulation of metabolic pathways, as well as acting as a natural blocker for the calcium channels. Our objective was to highlight the most recent clinical data with respect to daily Mg intake (DMI) and metabolic traits, particularly type 2 diabetes mellitus (DM). This was a PubMed-based review of the English-language medical papers across different key terms of search; the time frame was from January 2019 until April 2024. We included (clinically relevant) original studies and excluded cases reports, series, reviews, editorials, opinion, experimental studies, and non-human data as well as studies that did not specifically assessed DMI and only provided assays of serum Mg, studies on patients diagnosed with type 1 or secondary DM. A total of 30 studies were included and we organized the key findings into several sections as follows. Studies investigating DMI in relationship with the adherence to local recommendations in diabetic subjects (n = 2, one transversal and another retrospective cohort; N = 2823) found that most of them had lower DMI. Deficient DMI was correlated with the risk of developing/having DM across five studies (n = 5, one prospective and four of cross-sectional design; N = 47,166). An inverse correlation between DMI and DM prevalence was identified, but these data are presented amid a rather heterogeneous spectrum. Four novel studies (N = 7279) analysed the relationship between DMI and DM control according to various methods (HbA1c, fasting and postprandial glycaemia, and insulin); the association may be linear in diabetic subjects only at certain levels of DMI; additionally, the multifactorial influence on HBA1c should take into consideration this dietary determinant, as well, but there are no homogenous results. Three studies concerning DMI and diabetic complications (one cross-sectional, one prospective, and another case-control study) in terms of retinopathy (n = 1, N = 3794) and nephropathy (n = 2, N = 4805) suggested a lower DMI was associated with a higher risk of such complications. Additionally, two other studies (one prospective and one retrospective cohort) focused on mortality (N = 6744), which, taking only certain mortality indicators into consideration, might be decreased in the subgroups with a higher DMI. Seven studies (N = 30,610) analysed the perspective of DMI in the general population with the endpoint of different features amid glucose profile, particularly, insulin resistance. Concerning HOMA-IR, there were three confirmatory studies and one non-confirmatory, while fasting plasma glucose was highlighted as inversely correlated with a DMI (n = 1). The highest level of evidence regarding Mg supplementation effects on glucose metabolism stands on seven randomised controlled trials (N = 350). However, the sample size was reduced (from 14 to 86 individuals per study, either diabetic or pre-diabetic) and outcomes were rather discordant. These clinical aspects are essential from a multidisciplinary perspective and further trials are mandatory to address the current areas of discordant results.

Awareness About Osteoporosis Among the General Population Based on the Osteoporosis Knowledge Assessment Tool (OKAT): A Cross-Sectional Study in the Northern Border Region of Saudi Arabia

OBJECTIVE

Osteoporosis is a progressive systemic skeletal disease characterized by increasing susceptibility to fractures. The current study was conducted to assess the awareness about osteoporosis among the general population in the Northern Border region of Saudi Arabia to improve awareness and proper planning for public awareness about osteoporosis.

METHODS

The study was conducted as a cross-sectional survey study, based on the online distribution of the Arabic-translated Osteoporosis Knowledge Assessment Tool (OKAT). The questionnaire questions cover the demographic characteristics of the participants, as well as symptoms, risk factors, prevention, and knowledge of treatment centers for osteoporosis in Saudi Arabia.

RESULTS

395 participants were enrolled in the study after their informed consenting. After scoring all correct answers for each participant, the mean score of all participants' answers was 12.5±3.4 (range 0-19). Participants with poor knowledge (0-7 scores), moderate knowledge (8-13 scores), and good knowledge (13-20 scores) represent 61 (15.4%), 213 (53.9%), and 121 (30.6%), respectively. The mean percentage of right answers to all the questions is 44.1%. The highest awareness level was shown in the area of osteoporosis symptoms and risk of fractures, while the lowest was recorded in the questions covering the risk factors. Ages, genders, jobs, and levels of education significantly affected the participants' levels of awareness.

CONCLUSION

The public awareness among the population in the Northern Border region about osteoporosis is less than satisfactory. More awareness activities targeting the risky groups should be planned especially in the area of risk factors and preventive measures for osteoporosis.