Bone mineral density changes in hypercalciuretic osteoporotic men treated with thiazide diuretics.
A few studies suggest that thiazide diuretic agents may have modest beneficial effects on bone. Few data are available on the effects of these medications in patients with osteoporosis and hypercalciuria.


OBJECTIVE
To evaluate the effects of thiazide diuretic therapy on bone mass and urinary calcium excretion in hypercalciuretic osteoporotic male patients.


METHODS
Osteoporosis was defined as a greater than 2.5 standard deviation (S.D.) decrease in bone mineral density (BMD) at the lumbar spine or hip (T-score). We used an open-label prospective design to compare 14 patients with hypercalciuretic osteoporosis treated with a thiazide diuretic for 18 months and 13 patients with primary osteoporosis treated with calcium and vitamin D supplementation. Mean age was 53.5 +/- 9.6 years in the thiazide group and 48.7 +/- 8.4 years in the calcium-vitamin D supplementation group. The following serum parameters were assayed at baseline: 25OH-D3, 1,25OH-D3, parathyroid hormone (PTH), and bone turnover markers. Urinary calcium excretion and BMD by dual-energy X-ray absorptiometry at the spine and hip were determined at baseline and after 18 months of treatment.


RESULTS
Annual BMD increases were similar in the two groups during the 18-month treatment period: lumbar spine, 0.6 +/- 2.5% (P = 0.47) in the thiazide group and 0.004 +/- 3% (P = 0.78) in the supplementation group; femoral neck, 0.47 +/- 2.6% (P = 0.89) and 1.1 +/- 3.2% (P = 0.22); total hip, 0.65 +/- 2.5% (P = 0.37) and 0.12 +/- 2.1% (P = 0.51). Urinary calcium excretion fell by 45.9% in the thiazide group from baseline to study completion (P = 0.0015).


CONCLUSIONS
We found no evidence that thiazide therapy increased bone mass in patients with hypercalciuria and osteoporosis as compared to calcium-vitamin D supplementation in patients with osteoporosis but no hypercalciuria. In contrast, our results establish the efficacy of thiazide diuretics in reducing urinary calcium excretion, an effect that may decrease the risk of urinary lithiasis. Studies in larger patient cohorts treated for longer periods are needed to confirm or refute our findings.
Legroux-Gerot
Isabelle
I
Rheumatology Department, Lille Teaching Hospital, Roger Salengro Hospital, 59037 Lille cedex, France. i-legroux@chru-lille.fr
Catanzariti
Lionel
L
Marchandise
Xavier
X
Duquesnoy
Bernard
B
Cortet
Bernard
B
D001581:Benzothiadiazines; D015519:Bone Density / Q000187:drug effects*; D002118:Calcium / Q000652:urine*; D004232:Diuretics; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000378:metabolism; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000378:metabolism; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000652:urine*; D011446:Prospective Studies; D011859:Radiography; D049993:Sodium Chloride Symporter Inhibitors / Q000494:pharmacology*; D016896:Treatment Outcome
D001581:Benzothiadiazines; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D002118:Calcium