Medical therapy of metabolic damage to the bones caused by nephrolithiasis

In this article we have analyzed the data from the international literature related to the treatment of the osseous metabolic damage because of the recurrent nephrolithiasis. Main groups of medications are outlined, which are indicated for use in this situation: vitamin D and its active metabolites, citrates and thiazides bisphosphonates. Use of Vitamin D and its active metabolites (alfacalcidol and rocaltrol) is in this clinical scenario questionable, mainly due to the lack of evidence on the absence of negative influence on nephrolithiasis recurrence potential. Moreover some adverse effects on the cardiovascular system are to consider. Combination therapy using thiazides and citrates demonstrates a proven effect, which is nevertheless weak and deferred and therefore not always acceptable in clinical setting. Bisphosphonates have showed a relatively high efficacy and good safety profile. This group could be considered as therapy of choice in treatment of renal osteodystrophy due to nephrolithiasis. Also the combination therapy using bisphosphonates and thiazides is under review. Nevertheless the evidence regarding the efficacy and safety of this approach is still lacking.