Kidney Stones and Osteopenia or Osteoporosis

JRNJ

I just had a 7 mm kidney stone removed. I had a 14 mm 8 years ago, and no problems til now. I've been on prescription Vitamin D for a while, 50,000 units once a week prescribed by primary. I added calcium at advice of MO last May due to osteopenia dx. I also started taking Vitamin C in the last 6 months. And I got a steroid shot 4 weeks ago and was on steroids in early 2020 during chemo and after for a little while. From what I've read seems like the perfect storm for a kidney stone. Now I'm afraid to take the calcium, but what should I do? Should I just reduce the vitamin D, I think it is too high, or stop the calcium and ask for one of those shots (prolia, zometa, .....) MO told me to take calcium and has never mentioned a shot. And of course he did not look at my history, medications and big picture. Also, could this be a possible sign of cancer in my bones?

Also I had a clean CT scan in November 2020 and DIEP flap surgery 1/29/21. Could the surgery have triggered it? Lots of pain meds, in bed for 2 weeks.....

MinusTwo

JRN - My first course would be to get a DEXA scan and see exactly where on the osteopenia/osteoperosis scale you fall. Then I'd talk to the MO and maybe an endochronologist. I never stopped calcium, but I now take a Prolia shot every 6 months for osteoporosis caused by chemo drugs.

JRNJ

MinusTwo, I had one Feb 2020 2/3 into chemo and before radiation and AIs. I guess he thought it wasn't that bad and just said take calcium. He said insurance only pays for every other year, but he's been wrong about my insurance before and his office has screwed up my paperwork several times. I think we can justify it due to starting AIs. I read if you take too much vitamin D with the calcium, it could cause stones, so I think it's more the vitamin D than the calcium. In my search I read a post from Moth about this issue and finding the right balance of the vitamins. I would have never thought to go to an endochronologist. Sure, I'm on a roll, I need to find one of every Dr. lol. Does the endochronologist do the Prolia shots? I thought it would come from the MO. I'll talk to my MO the next time I see him. I don't know the difference between Prolia and Zometa.

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keepthefaith

You may want to research taking Vitamin K2 with your other supplements. It is supposed to help the calcium be absorbed into your bones and not in other places...

I believe there is another thread on the forum that discusses it. Best wishes!

SpecialK

jrnj - sorry you found yourself with a kidney stone - that's a bummer! Did you have a lithotripsy to treat it? That you have had a previous kidney stone, prior to breast cancer, I would think would bode for this to be more of a coincidence rather than cause/effect relates to cancer or recurrence Do you know what your serum calcium level is? Have you had your D level checked lately? If your calcium is in the normal range (adjusted for age - calcium should be slightly lower as we get older) I wouldn't think this would be a danger. Your prescription D is likely to be D2, you might want to switch to a smaller dose of D3 - the over the counter kind, taken daily with your largest meal, as some have had better success in raising their D level, or keeping it stable, with a daily dose of D3 rather than a megadose of D2. Also, consider adding K2 and magnesium with your calcium as suggested above. You can find some supplements that combine all that together rather than having to take a handful of different things. If you receive Reclast or Prolia you will likely be advised to continue supplementing with Vit D and calcium - that is what I was told and what I've seen here as well. Reclast is a bisphosphanate infusion - usually annually, the same type of drug as Actonel, Fosamax, and Boniva which are the oral forms. Prolia is an injectable monoclonal antibody given every six months. Both slow the turnover of old bone so the creation of new bone can catch up - but work by slightly differing mechanisms. Also, endocrinologists generally handle this area as it is their field and they do give bone stregthening meds, oncologists infuse patients with bone cancer or bone mets so have familiarity with these drugs for that, but less so for bone density purposes. It has become more common for oncologists to prescribe bone stregthening meds to their breast cancer patients because anti-hormonals can cause a loss of bone density, but I think many don't spend a lot of time delving into the complications their patients may have on them. There has also been some evidence that these drugs inhibit potential bone mets by helping provide a less hospitable environment for them so prescribing them has fallen into the purview of some oncologists. Insurance coverage for DEXA scans is generally in line with the World Health Organization recommendation of every two years, but more frequent scans can be covered for medically necessary purposes. Bone strengthening drugs tend to work fairly slowly so you often don't see measurable improvement in less than two years.

SUPer52

JRNJ,

Was your kidney stone tested to see what caused it, or did your doctor run any blood or urine tests? I understand your concern about what kidney stones might mean for someone with a history of breast cancer. Hopefully the two are unrelated for you.

There are multiple causes of kidney stones, with the primary reason being not drinking enough water. A diet high in sodium is also a risk fact. However, there are other causes as well, including eating what would otherwise be considered a healthy diet. My first (and so far only) kidney stone landed me in the ER 36 hours before I was scheduled for my re-excision. That was probably the last thing on my radar at the time, so when I was awakened at 1:30 AM with searing pain in my back and uncontrolled vomiting, I had no idea what was happening.

You mention that you had been in bed for two weeks recovering from surgery, which absolutely could be at least a partial cause, as you probably did not drink as much water as you normally would. I believe this is what happened to me because prior to my first BC surgery, I had knee surgery that had me laid up for some time and hubby was not so great at bringing me things I needed such as a glass of water every once in a while after the knee surgery or the first BC surgery LOL!!

Anyway, my stone was tested and it was determined that it was caused by excessive calcium oxalate. Contrary to what that label indicates, this wasn't because of excessive calcium in my blood but rather a diet high in oxalates and actually not enough calcium in my diet. Many healthy foods (that many breast cancer patients and survivors are encouraged to eat) are high in oxalate (think spinach, berries, whole grains, many veggies, etc.). Many other commonly consumed foods and beverages such as coffee, tea, nuts, etc. are also high in oxalate. Apparently my body can't handle the load of oxalate (some people can and some can't). I had not been drinking enough water, had been eating a lot of healthy foods high in oxalate, and had been avoiding dairy due to the ER+ tumor, all of which created the perfect storm for me. The urologist had me undergo a 48 hour urine analysis to measure the oxalate in my urine and it was high. The diet he recommended was in several ways in conflict with the healthy diet I follow to minimize my risk of breast cancer recurrence. I was told by both the urologist and his PA that some other things I could do to counteract the high oxalate when I consume certain foods was to eat some dairy or other calcium-rich foods as calcium actually absorbs the oxalate. They also said taking vitamin B6 has been shown to reduce the risk of developing kidney stones.

Here's to hoping that your kidney stone is completely unrelated to your BC. Here is some information from Harvard Health regarding kidney stones. https://www.health.harvard.edu/blog/5-steps-for-pr...

edj3

Echoing the advice for you to get a referral to an endocrinologist. In fact, my MO was the one who said he wanted me to see one since I had a history of broken bones w/o a fall.

jhl

JRNJ,

I will echo what SUper52 said. Was your stone examined? A significant percentage of kidney stones are as she mentioned oxalate or uric acid which means your calcium & Vitamin D did not contribute. However, I would definitely ask your urologist if you should continue to take calcium. Some of us really don't need it and it is a fallacy to assume we all do. I would follow your urologist's recommendation with regard to taking calcium supplements rather than your MO. Your MO's recommendation is standard when prescribing an AI. But, one size does not fit all. I don't think your Vitamin D supplementation is a significant contributor either. However, taking Vitamin C when you are not actually deficient (which is very rare in a first world country) is a contributor to oxalate stones. The body converts Vitamin C into oxalate. So, I think you should discontinue that.

Jane

wallycat

Several things you can try and a few are anecdotal.

My neighbor has horrible kidney stones; his doctor said drinking beer helps his stay at bay.

Potassium supplements can help.

Also, as someone mentioned, did they tell you which kind of stone you had? It may be as simple as adding vitamin C.

JRNJ

Thanks all. I had uteroscopy because it was in the tube. In 2013 I had lithotripsy and 4 days later uteroscopy. Both my stones were calcium stones. I did the 24 hour urine test in 2013 and all he told me was to drink more water. Urologist has not given me any advice on food or supplements, just drink more water. I asked him and he said "I don't know, you need calcium for your bones". I went off all meds except letrozole and lunesta to detox my body. Had bloodwork yesterday. Calcium was normal I was not tested for Vitamin D because the order was from my rheumatologist. I will probably lower vitamin D, continue calcium and stop vitamin C. However, the suggestion to see an endochronologist may be expedited. I just got some bloodwork back that is freaking me out. I am going to start a new post on that. Thanks!!!

SeeQ

JRNJ, have your docs checked your calcium levels and parathyroid hormone (PTH)? Sorry if you addressed this already.

This thread caught my eye, because at my recent endocrinologist appt the doc seemed pretty surprised I hadn't had kidney stones. Osteopenia and kidney stones are two common side effects of hyperparathyroidism.

There's more info at parathyroid.com and hyperparathyroidmd.com that could help you talk to your MO.

There are also a couple discussion threads about parathyroid on BCO.

I've had high calcium for about a year, and two high PTH tests; I also have osteopenia. I'm currently awaiting scan and u/s, and likely minor surgery to correct the problem.

Edited to add - well, shoot, now I see it in your last post. It looks like you're headed in a different direction, though.

JRNJ

SeeQ, Thank you for the advice. I have all the symptoms of hyperthyroid. It turns out that even though 3 drs. told me my bloodwork is normal, I had a thyroid US that turned up 3 suspicious nodules and I am going for a biopsy.