Hosam K. Kamel, MD
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Kamel HK. Low-Dose Thiazide and Bone Density. Ann Intern Med. 2002;136:252. doi: 10.7326/0003-4819-136-3-200202050-00018
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Published: Ann Intern Med. 2002;136(3):252.
TO THE EDITOR:
LaCroix and colleagues (1), in a 3-year randomized, controlled trial, demonstrated that low-dose hydrochlorothiazide increased bone density in elderly normotensive men and women. They subsequently recommended considering hydrochlorothiazide in osteoporosis prevention programs. I believe this recommendation is too general and deserves further clarification.
The beneficial effect of hydrochlorothiazide on bone is probably related to its action on kidney tubules to promote calcium reabsorption. Urinary calcium excretion increases in postmenopausal women. This physiologic phenomenon, also known as postmenopausal renal calcium leak, has been attributed to reduced tubular reabsorption of calcium secondary to decreased estrogen effect on kidney tubules in the postmenopausal period (2). In the trial by LaCroix and colleagues, the greater effect of hydrochlorothiazide on bone density in women than in men is probably linked to postmenopausal calcium leak. The relationship between urinary calcium excretion and effect on bone density was not assessed in this study.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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