Total hip BMD lower in men who used loop diuretics

Older men using loop diuretics may experience increased hip bone loss, according to data published in the Archives of Internal Medicine.

Researchers from Minnesota and Connecticut conducted a cohort study of 3,269 men aged 65 years and older who were continuous users of loop diuretics (n=84), intermittent users (n=181) and non-users (n=3,004) to determine the link between loop diuretic use and BMD.

Hip BMD was measured at baseline and at an average of 4.6 years later. The researchers found that the annual rate of decline in total hip BMD increased with use of loop diurectics. The annual rate of decline was –0.33% (95% CI, –0.36% to –0.31%) for nonusers; –0.58% (95% CI, –0.69% to –0.47%) for intermittent users; and –0.78% (95% CI, –0.96% to –0.60%) for continuous users.

Change in BMD at the femoral neck and trochanter were similar, according to the researchers. – by Stacey L. Adams

Arch Intern Med. 2008;168:735-740.

This is the largest observational study of male osteoporosis that we have available for review, so I think this is an important cohort in which to understand the effects of different lifestyle and interventional modifications on skeletal health by following these men longitudinally. The authors very nicely show an association between use of diuretics — either intermittent or continuous — with declines in total hip BMD through an annualized assessment of declines in BMD. This is an interesting association to understand because diuretic use is common and, as the authors point out, there is a calciuretic effect that can influence skeletal health. I think it will be helpful to further evaluate this kind of association and understand some of the clinical outcomes including effects on skeletal remodeling, as could be assessed by biochemical markers of bone turnover, as well as fracture outcome.

– Rachel B. Wagman, MD

Adjunct Clinical Assistant Professor
Department of Medicine, Stanford University School of Medicine