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Rapid Recovery of Bone Mass in Hypercalciuric, Osteoporotic Men Treated with Hydrochlorothiazide

John S. Adams, MD; Cindy F. Song, BS; and Vitaly Kantorovich, MD
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From Burns and Allen Research Institute and Cedars-Sinai Medical Center, University of California, Los Angeles, School of Medicine, Los Angeles, California.

Ann Intern Med. 1999;130(8):658-660. doi:10.7326/0003-4819-130-8-199904200-00012
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Background: Chronic hypercalciuria can contribute to osteoporosis, particularly in men.

Objective: To ascertain the effects of resolution of hypercalciuria on bone mineral density.

Design: Case series.

Setting: Referral service for metabolic bone disease in a tertiary-care teaching hospital.

Patients: Five male patients (42 to 66 years of age) with hypercalciuria and osteoporosis.

Intervention: Hydrochlorothiazide, 25 mg twice daily, for a mean (± SD) of 7.8 ± 3.6 months.

Measurements: Fasting urinary calcium:creatinine ratio, serum calciotropic hormone levels, and bone mineral density before and after hydrochlorothiazide administration.

Results: Hydrochlorothiazide resolved hypercalciuria and increased bone mineral density at a rate of 8% and 3% per year at the spine and hip, respectively.

Conclusions: Hydrochlorothiazide treatment in hypercalciuric and osteoporotic men was associated with a rapid rebound increase in bone mineral density.


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Fasting urinary calcium:creatinine ratio (top left), serum 1,25-dihydroxyvitamin D levels (bottom left), lumbar spine bone density (top right), and femoral neck bone density (bottom right) in five hypercalciuric men with osteoporosis before (black squares) and after (white squares) twice-daily treatment with 25 mg of hydrochlorothiazide.

A urine calcium:creatinine ratio of 0.18 or less was considered normal.

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