الفهرس 
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Abstract
Introduction: Hypercalciuria is common in patients with osteoporosis. However, the long-term effect of urinary calcium excretion (UCaE) on overall patients’ health is not very well-examined. The aim of work: to assess the impact of UCaE on kidney, skeletal, and cardiovascular outcomes in patients with osteoporosis. Research Plan: Longitudinal study of patients with osteoporosis who underwent bone biopsy and 24-hour urine collection between 2008-2015. DXA scans, serum markers, kidney function, and cardiovascular events were recorded until last visit in 2021. Exclusion criteria were secondary osteoporosis or conditions that significantly impact UCaE. Results: Study included 230 patients with mean follow-up of 7.2 years. Hypercalciuria was found in one-third of patients with no difference between low and high bone turnover. UCaE correlated positively with eGFR but did not affect the rate of eGFR decline over time. Higher UCaE predicted kidney stones development. Hypercalciuria predicted loss of BMD at all sites, but also hypocalciuria was associated with higher loss in total hip BMD. Upper limb fractures were the most observed fractures, and their incidence was higher in patients with hyper- or hypo-calciuria. Lower UCaE independently predicted development of major adverse cardiac events (MACE) and cardiovascular disease (CVD). Conclusion: UCaE did not affect the change of eGFR over time. Patients with normal UCaE had lower incidence of upper limb fractures and less reduction in BMD. Low UCaE predicted MACE and CVD.