title: The effect of thiazide and loop diuretics on urinary levels of free deoxypyridinoline: an osteoclastic bone-resorption marker.
abstract: OBJECTIVE
  Diuretics can cause changes in calcium levels due to renal effects. Moreover, calcium levels can also vary as a result of changes in intestinal absorption and in the activity of osteoclastic cells. A marker of osteoclastic bone-resorption activity is the level of urinary free deoxypyridinoline (FDP). Deoxypyridinoline (DP) acts as a cross-link between adjacent collagen chains to provide structural rigidity. Our aim was to investigate the association between use of thiazides and loop diuretics and urinary levels FDP.
  
  
  METHODS
  In this follow-up study, data were obtained from the Rotterdam Study, a large population-based prospective cohort study. For a subset of 658 participants, urinary levels of FDP were measured at baseline. Linear regression analysis was performed to assess the association between the use of thiazides and loop diuretics and the urinary levels of FDP.
  
  
  RESULTS
  In women, current use of loop diuretics for less than 42 days was associated with an increased level of urinary FDP (+3·43 nmol deoxypyridinoline per mmol urinary creatinine; 95% CI 1·85; 5·02) compared with no use. However, use for a period of more than 42 days was not associated with an increased level of FDP, nor was past use of loop diuretics. For thiazide diuretics, no statistically significant associations were found.
  
  
  CONCLUSIONS
  In women, short-term use of loop diuretics is associated with an increased level of FDP, reflecting increased bone resorption by osteoclasts. As the difference disappears with longer term use, the clinical significance is unclear and the value of FDP as a biomarker in this setting is not established. The molecular mechanism for the observed differences in bone fracture rates with use of diuretics remains unclear.
authors: Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands.
authors: R
authors: R
authors: Ruiter
authors: L
authors: L
authors: Oei
authors: L E
authors: LE
authors: Visser
authors: H G
authors: HG
authors: Peltenburg
authors: A
authors: A
authors: Hofman
authors: M C
authors: MC
authors: Zillikens
authors: A G
authors: AG
authors: Uitterlinden
authors: F
authors: F
authors: Rivadeneira
authors: B H
authors: BH
authors: Stricker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000596:Amino Acids / Q000652:urine*; D015415:Biomarkers / Q000652:urine; D015519:Bone Density / Q000187:drug effects; D001862:Bone Resorption / Q000188:drug therapy* / Q000652:urine*; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010010:Osteoclasts / Q000187:drug effects; D011446:Prospective Studies; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use*; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use*
chemical_list: D000596:Amino Acids; D015415:Biomarkers; D049993:Sodium Chloride Symporter Inhibitors; D049994:Sodium Potassium Chloride Symporter Inhibitors; C036020:deoxypyridinoline