Kidney stones and metabolic bone diseases not linked to parathyroid disfunction: a proposal for an integrated management.

Nephrolithiasis (KS) and metabolic bone diseases (MBDs) not linked to parathormone (osteoporosis, Paget's disease of bone and renal phosphate leak) are related as demonstrated by epidemiological and experimental data. Moreover, patients affected by monogenic kidney stone disorders (idiopathic hypercalciuria, primary hyperoxaluria, hypocitraturia, cystinuria and defects in purine metabolism) showed a bone phenotype. A significant economic and social burden is associated with KS and MBDs, due to high mortality and morbidity rate. Concerning this point of view, an integrated screening could be a cost-saving strategy. We suggest a new clinical management for patients affected by KS and MBDs. The assessment of bone mineral density by Dual X-ray absorptiometry and bone turnover markers should be proposed in KS patients. On the contrary, the evaluation of KS-related metabolic risk factor and an abdomen ultrasound exam should be offered to MBD patients. Moreover, in patients with early and/or recurrent KS, an extended gene-panel should be suggested.