Low-Dose Hydrochlorothiazide and Preservation of Bone Mineral Density in Older Adults

LaCroix, Andrea Z.; Ott, Susan M.; Ichikawa, Laura; Scholes, Delia; Barlow, William E.

doi:10.7326/0003-4819-133-7-200010030-00010

Cited by 187 publications

(138 citation statements)

References 36 publications

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“…Several prospective studies in older adults have shown that thiazide use is associated with reduced hip fracture incidence (35) and increased BMD (36,37). Similarly, one study has shown increased vertebral and femoral neck BMD in osteopenic women treated with potassium citrate compared with controls (38).…”

Section: Discussionmentioning

confidence: 99%

Risk of Fracture in Urolithiasis

Denburg

Leonard

Haynes

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Studies have shown decreased bone mineral density in individuals with urolithiasis, but their burden of fracture remains unclear. This study sought to determine whether urolithiasis is associated with increased fracture risk across the lifespan and to delineate sex effects.Design, setting, participants, & measurements A population-based retrospective cohort study using The Health Improvement Network was performed. The median calendar year for the start of the observation period was 2004 (1994-2012). This study identified 51,785 participants with $1 of 87 diagnostic codes for urolithiasis and 517,267 randomly selected age-, sex-, and practice-matched participants. Cox regression was used to estimate the hazard ratio (HR) for first fracture. Fractures identified using diagnostic codes were classified by anatomic site.Results Median age was 53 years, and 67% of participants were men, confirming their greater urolithiasis burden. Median time from urolithiasis diagnosis to fracture was 10 years. The HR for fracture associated with urolithiasis differed by sex and age (P for interactions, P#0.003). In men, the adjusted HR was greatest in adolescence (1.55; 95% confidence interval [95% CI], 1.07 to 2.25) with an overall HR of 1.10 (95% CI, 1.05 to 1.16). Urolithiasis was associated with higher fracture risk in women aged 30-79 years (HR, 1.17-1.52), and was highest in women aged 30-39 years (HR, 1.52; 95% CI, 1.23 to 1.87). Peak background fracture rates were highest in boys aged 10-19 years and in women aged 70-79 years. The incidence per 10,000 person-years in participants with versus without urolithiasis was 392 versus 258 in male participants aged 10-19 years, and 263 versus 218 in women aged 70-79 years. Distribution of fracture site within sex did not differ between participants with versus without urolithiasis.Conclusions Urolithiasis was associated with higher incident fracture risk. The significantly higher risk at times of peak background fracture incidence in adolescent boys and elderly women has profound public health implications.

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Section: Discussionmentioning

confidence: 99%

Risk of Fracture in Urolithiasis

Denburg

Leonard

Haynes

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…Na falta de resposta compensatória, a hipercalciúria predispõe ao balanço negativo de cálcio e aumento da atividade osteoclástica e remodelação óssea. Por outro lado, estudos demonstraram que o controle da hipercalciúria, com o uso de diuréticos tiazídicos, reduz a perda óssea, podendo até recuperar a massa óssea em mulheres e homens com osteoporose (8)(9)(10). Vários protocolos recomendam que na investigação dos pacientes com osteoporose deva ser incluída, entre outros exames, a calciúria de 24 horas.…”

Section: Discussionunclassified

Prevalência de hipercalciúria em mulheres na pós-menopausa com osteoporose

Carvalho

Kulak

Borba

2012

Arq Bras Endocrinol Metab

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RESUMOObjetivo: Analisar a prevalência de hipercalciúria em mulheres na pós-menopausa com osteoporose e avaliar associação de hipercalciúria com parâmetros clínicos e do metabolismo osteomineral. Sujeitos e métodos: Foram estudadas 127 mulheres. A calciúria foi determinada em urina de 24 horas. A DMO foi medida em coluna lombar e fêmur por dupla emissão de energia (DXA). Resultados: A média de idade foi de 64 ± 8 anos. De acordo com a excreção urinária de cálcio, as pacientes foram divididas em normo e hipercalciúricas (HC). Das 127 pacientes, 19 (15%) foram classificadas como HC. Houve diferença entre os grupos apenas na idade de início da menopausa (46 ± 6 vs. 50 ± 3 anos HC, p < 0,0005). Não houve associação entre calciúria e idade, IMC, DMO, cálcio, fósforo, PTH e fosfatase alcalina. Conclusão: A HC é frequente em mulheres na pós-menopausa com osteoporose, e a medida da calciúria deve ser incluída na investigação dessas pacientes. Arq Bras Endocrinol Metab. 2012;56(1):1-5 Descritores Hipercalciúria; osteoporose; densidade óssea; hormônio paratireóideo ABSTRACT Objective: To determine the prevalence of hypercalciuria (HC) in postmenopausal women with osteoporosis and its relationship with clinical data and bone mineral metabolism. Subjects and methods: Calciuria was measured in 24-hour urine samples of 127 women. BMD was measured in the lumbar spine and femur by dual-energy X-ray absorptiometry (DXA). Results: Mean age (±SD) was 64 (±8) years. According to urinary calcium excretion, patients were divided into normo-and hypercalciuric (HC). Of the 127 patients, 19 (15%) were classified as HC. The only difference between the groups was the age of onset of menopause (46 ± 6 vs. 50 ± 3 years HC, p < 0.0005). No association was found between calciuria and age, BMI, BMD, calcium, phosphorus, PTH, and alkaline phosphatase. Conclusion: HC is frequent in postmenopausal women with osteoporosis, and calciuria measurement should be included in the investigation of these patients. Arq Bras Endocrinol Metab. 2012;56(1):1-5 Keywords Hypercalciuria; osteoporosis; bone density; parathyroid hormone INTRODUÇÃO A osteoporose é definida como um distúrbio esquelé-tico caracterizado por diminuição da massa e deterioração da microarquitetura óssea, que leva à piora da qualidade do osso e, por consequência, ocasiona aumento do risco de fraturas por fragilidade (1). A medida da densidade mineral óssea, por meio da absorciometria de raios X de dupla energia (DXA), é utilizada como meio diagnóstico e representa aproximadamente 70% da massa óssea total. A Organização Mundial da Saúde definiu osteoporose como densidade mineral óssea (DMO) menor que 2,5 desvios-padrão abaixo da média de uma população de adultos jovens (2).

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“…66,67 They are the only medications for which we found some published reports of use in people with SCI, with possibly promising results. [68][69][70] Thiazide diuretics were shown to slow down cortical bone loss in healthy postmenopausal women 71 and in healthy older adults 72 but with modest effects overall, 71,72 somewhat stronger in women. 72 A new bone formation enhancing drug, recombinant human parathyroid hormone, which has recently been approved in the USA and Europe, has been shown to increase bone mass and reduce incidence of both vertebral and nonvertebral fractures.…”

Section: Discussionmentioning

confidence: 99%

“…[68][69][70] Thiazide diuretics were shown to slow down cortical bone loss in healthy postmenopausal women 71 and in healthy older adults 72 but with modest effects overall, 71,72 somewhat stronger in women. 72 A new bone formation enhancing drug, recombinant human parathyroid hormone, which has recently been approved in the USA and Europe, has been shown to increase bone mass and reduce incidence of both vertebral and nonvertebral fractures. [73][74][75] In an effort to achieve stronger therapeutic effects, combination treatments for osteoporosis are beginning to be explored, and while it seems that combinations of some antiresorptive treatments may have synergistic effect, 76 optimal ways of combining them with bone formation stimulating drugs without reducing the anabolic effect of the latter are yet to be found.…”

Section: Discussionmentioning

confidence: 99%

Hormone replacement therapy in women with spinal cord injury – a survey with literature review

et al. 2004

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Study design: Postal questionnaire survey. Objective: To examine the current use of hormone replacement therapy (HRT) in a sample of menopausal women with spinal cord injury (SCI). Setting: National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital, Aylesbury, UK. Method: A postal questionnaire was sent to 94 women from the NSIC patient database who met the study inclusion criteria (wheelchair dependent, aged 49 years and above, last seen or heard from within the last 3 years).Results: A total of 59 valid questionnaires were analysed. At the time of the survey, 50 women were menopausal and 11 of them were using HRT, six for menopausal symptoms and five for osteoporosis prevention. Another 11 had used HRT, eight for menopausal symptoms and three for osteoporosis prevention, but had discontinued it. The main reasons for stopping HRT were side effects. Of the 28 women who had never been on HRT, 20 had either enquired about it, or had been offered HRT, but decided against it. Of the nine women who were still premenopausal at the time of the survey, four would consider using HRT. Conclusions: Results show that 44% of the menopausal women in our sample have used HRT at some point and 22% still do, mostly for treatment of menopausal symptoms and for osteoporosis prevention. In view of the latest literature findings in able-bodied women, use of HRT for osteoporosis prevention in women with SCI may have to be reconsidered.

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Low-Dose Hydrochlorothiazide and Preservation of Bone Mineral Density in Older Adults

Cited by 187 publications

References 36 publications

Risk of Fracture in Urolithiasis

Risk of Fracture in Urolithiasis

Prevalência de hipercalciúria em mulheres na pós-menopausa com osteoporose

Hormone replacement therapy in women with spinal cord injury – a survey with literature review

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