Bone Quality and Vascular Health in Adolescents with Urinary Stone Disease

Urinary stone disease (USD) is common and increasingly recognized as a chronic systemic disorder with skeletal and vascular morbidity. The incidence of USD is increasing disproportionately among adolescents, making it critical to understand its impact on bone and vascular health in this population.

Identifying modifiable factors that compromise bone strength and vascular health will facilitate the development of strategies to reduce fracture rates and cardiovascular events across a person’s life. The primary objectives of this study are to (1) evaluate the impact of USD on gains in bone density, structure, and strength in adolescents and identify modifiable predictors of changes in bone strength via urine metabolic profiling and dietary assessment; and (2) determine if USD is associated with subclinical vascular disease and if markers of vascular disease are associated with lower bone strength in adolescents with USD.

A second generation high-resolution peripheral quantitative computed tomography (HR-pQCT) device will be used to assess bone microarchitecture and micro-finite element analysis (μFEA) estimates of bone strength (failure load) that are highly correlated with ex vivo biomechanical testing. Vascular assessment will combine markers of arterial stiffness (pulse wave velocity/analysis), subclinical atherosclerosis (carotid intima-media thickness), and endothelial function (EndoPAT), all of which have been shown to independently predict cardiovascular events in adults. The results of this study will inform future multicenter clinical trials of interventions to promote bone accrual and vascular health in adolescents with USD.