Link Between Bone Loss And Diuretics In Older Men

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Main Category: Bones / Orthopaedics
Also Included In: Urology / Nephrology;  Cardiovascular / Cardiology;  Hypertension
Article Date: 17 Apr 2008 - 0:00 PDT

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According to a study published in the Archives of Internal Medicine, researchers have found increased rates of hip bone loss in older men who take frequently prescribed heart failure and hypertension drugs called loop diuretics.

Study author Lionel S. Lim M.D., M.P.H. (Griffin Hospital, Derby, Conn.) and colleagues indicate that, "Loop diuretics are one of the most commonly prescribed medications among older adults." Since loop diuretics increase the amount of calcium discharged in urine, it is possible that bones are damaged over time. Previous observational studies have shown that patients who use loop diuretic increase the likelihood of hip and other fractures. "However, there is uncertainty as to whether this increased fracture risk is attributable to negative effects on bone mineral density, fall-related mechanisms (e.g., dizziness and orthostasis [low blood pressure when standing up]), or associated comorbidities [co-occurring illnesses]," detail the researchers.

To investigate the interaction between diuretics and fracture risk, Lim and colleagues analyzed a sample 3,269 men aged 65 and older. Initial examinations took place between 2000 and 2002, and patients received follow-up examinations about 4.6 years later. The researchers collected data on medication use (including a visual analysis of medication containers that the patient used during the past 30 days). In addition, participants had bone mineral density measured of the total hip and two subregions.

Of the 3,269 men, 84 used loop diuretics continuously during the two examinations, 181 used them occasionally, and 3,004 did not use them at all. The researchers found that the average rate of decline in total hip bone mineral density, controlling for other related factors, -0.33% in non-users, -0.58% in occasional users, and -0.78% in continuous users.

"Compared with rates of hip bone loss among non-users of diuretics, adjusted rates of loss were about two-fold greater among intermittent loop diuretic users and about 2.5-fold greater among continuous loop diuretic users," write the authors. The results were similar when using measurements from the hip subregion.

The researchers recommend that future research should focus on the underlying mechanisms. The authors conclude that, "Loop diuretic use in older men in associated with increased rates of hip bone loss. Our findings suggest that health care providers should take into account loop diuretic use when evaluating older men for risk factors for bone loss and fracture risk."

Loop Diuretic Use and Increased Rates of Hip Bone Loss in Older Men
Lionel S. Lim, MD, MPH; Howard A. Fink, MD, MPH; Michael A. Kuskowski, PhD; Brent C. Taylor, PhD; John T. Schousboe, MD, MS; Kristine E. Ensrud, MD, MS; for the Osteoporotic Fractures in Men (MrOS) Study Group
Archives of Internal Medicine (2008). 168[7]: 735-740.
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Written by: Peter M Crosta
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