Effectiveness of thiazides on serum and urinary calcium levels and bone mineral density in patients with osteoporosis: a systematic review and meta-analysis

Abstract

ObjectiveOsteoporosis is the most common metabolic bone disease and a major public health problem worldwide. Thiazides are widely used as antihypertensive agents with good tolerability and efficacy. Furthermore, thiazides have long been regarded as candidates for the prevention of postmenopausal bone loss. However, there is insufficient evidence that thiazides have a sustained beneficial effect on preserving bone mass and preventing osteoporosis to date.Materials and methodsWe searched the PubMed, the Cochrane Library, and Embase in June 2018 for randomized controlled trials on the use of thiazides to treat osteoporosis. Continuous outcomes are presented as the standardized mean difference (SMD) and 95% CI. Furthermore, P-values <0.05 were considered significant.ResultsFive trials with 756 patients were randomly assigned in the five trials included in this meta-analysis. Serum calcium level was higher in the thiazide group than in the control group (SMD 0.33, 95% CI [0.16, 0.50]), and urinary calcium level was significantly lower in the thiazide group (SMD −0.35, 95% CI [−0.52, −0.17]). There was no significant difference in bone mineral density between the two groups (SMD 0.19, 95% CI [−0.16, 0.54]).ConclusionThiazides might play a role in preserving bone mass and be effective in the prevention and treatment of osteoporosis. Future high-quality trials are needed to confirm our findings in the future.

Urine and Serum Electrolytes and Biochemical Values Associated with Osteoporosis in Premenopausal and Postmenopausal Women: A Longitudinal and Cross-Sectional Study Using Korean Genome and Epidemiology Study (KoGES) Cohort

“…Several risk factors for osteoporosis have been revealed, such as age, sex, menopause, obesity, a family history of osteoporosis, and metabolic disorders related to bone health [ 22 ]. Although calcium metabolism is a critical factor in maintaining bone health, well-designed clinical research on the relationship between bone loss, calcium, and other electrolytes has been very limited [ 23 , 24 , 25 ].…”

K+-Cl− cotransporter 1 (KCC1): a housekeeping membrane protein that plays key supplemental roles in hematopoietic and cancer cells

“…NCC, another member of the CCC family, has been drawing attention in the field of osteoporosis for many years because its inactivation—through thiazide therapy or homozygous loss of function mutations—has been shown to increase bone mineral density [99]. While this effect has been generally attributed to the secondary role of NCC in Ca 2+ handling by the gut and the kidney [100, 101]—NCC inactivation increases Ca 2+ absorption in both epithelia—it could also be attributed to the presence of NCC in the bone.…”

Efficacy and Safety of Postmenopausal Osteoporosis Treatments: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

“…c During open-label period, each patient was administrated denosumab subcutaneously every 6 months for additional 12 months. (1) The author considered that all deaths were unrelated to study drug. (2) The reasons of death were not defined in the 7-year dataset.…”