Loop diuretics: furosemide, bumetanide, torasemide, ethacrynic acid. IV. Thiazides, thiazide-like Osteoporosis (thiazides to decrease Ca2+ excretion into urine). - Nephrogenic diabetes . (CF = loss-of-function mutation of an ATP- driven Cl-. Thiazide is a type of molecule and a class of diuretics often used to treat hypertension (high stimulate osteoblast differentiation and bone mineral formation, further slowing the course of osteoporosis. for drugs with a similar action that do not have the thiazide chemical structure, such as chlorthalidone and metolazone. To Dr. Pia Eiken; your ability to revise and structure scientific papers is The relationship between osteoporosis, thiazide diuretics and hyponatremia is . and activity of osteoclasts which adhere to the trabecular surface and resorb bone.
Loop diuretics can induce hypotension, potentially causing dizziness and falls. Although diuretics as a group have been found to be associated with an increased risk of falling, there is some uncertainty as to whether loop diuretics, in particular, are associated with fall risk There are conflicting data on whether loop diuretic are associated with an increased risk of hip and other osteoporotic fractures.
Some observational studies suggest a positive association 11 - 14while others demonstrate no association 15 Furthermore, there is uncertainty as to whether the increased fracture risk with loop diuretic use shown in the former studies were due to the negative effects of loop diuretics on BMD, increased falls risk, or co-morbidities associated with loop diuretic use.
To test the hypotheses that loop diuretic use is associated with a higher rate of hip bone loss and increased risk of falls and fractures, we ascertained loop diuretic use and measured hip BMD in a cohort of older women enrolled in the Study of Osteoporotic Fracture. We followed participants prospectively for changes in loop diuretic use and hip BMD, and risk of incident falls and nonspine fractures.
This study recruited women aged 65 years and older between September and October from 4 regions in the United States: Women who were unable to walk without assistance and those with a previous history of bilateral hip replacements were also excluded.
A total of women completed at least the questionnaire portion of the 4th examination. Of these, provided data on medication use at this examination, of whom had at least partial data for the 5th examination December to December ; had at least partial data for the 6th examination January to February ; and had at least partial data for the 8th examination January to April Written informed consent was obtained from all study participants and appropriate institutional review boards were approved for the study.
Bone loss study cohort In order to be included in the bone loss cohort, participants must have had medication use data and hip BMD data at both the 4th and 6th examinations. The mean time between examinations was 4. Of the women at the 4th examination, also had medication use data at the 6th examination Figure 1.
Loop Diuretic Use And Rates Of Hip Bone Loss, And Risk Of Falls And Fractures In Older Women
Moreover, in order to distinguish between the osteo-toxic effect of loop diuretics and that presumably attributed to the thiazide diuretics, it should be noted that the possible mechanisms for loop diuretics include their calciuric effect, subsequent increase in plasma parathyroid hormone level, and decreased bone mineral density [ 15 - 17 ]. The spine is particularly vulnerable to micro-damage ,e. Thus, a retrospective study has been carried out to clarify whether, in our experience, the regular use of thiazide diuretics administered as anti-hypertensive therapy may be associated with a significantly increased risk of osteoporotic vertebral fractures in female patients aged 65 or over.
Methods In this two-center retrospective case-control study, we followed up a cohort of female patients with and without thiazide-induced hyponatremia. The relevant data were collected by review of medical records that were thoroughly analyzed.
- Loop Diuretic Use And Rates Of Hip Bone Loss, And Risk Of Falls And Fractures In Older Women
In addition, a further requirement for enrollment in this retrospective study was that antihypertensive therapy should consist of a thiazide diuretic hydrochlorothiazide, chlortalidone, indapamide, metolazone, etc. Particular attention was paid to the finding of any hyponatremia isolated or repeated in the patient history.
Moreover, special attention was paid to the diagnostic evaluation of cases of osteoporotic vertebral fracture.
The study included a scrupulous anamnestic investigation able to highlight a possible history of fracture, lesion, or collapse of one or more vertebrae. In the vast majority of cases, all relevant information was acquired without directly contacting patients, but simply through the scrupulous examination of the history and clinical data contained in the medical records.
The Hospital Directorates were informed in this regard, while no informed consent of the patients nor the preventive interpellation of the Ethics Committee was deemed necessary, since it was a non-experimental retrospective study, while the due attention was paid to the anonymity of the patient.
However, even a simple medical report e. We included vertebral fractures that were related to low or moderate trauma e. We excluded vertebral fractures due to high trauma e.
We also excluded cases of cervical or sacral fracture. We included in the analysis only cases of vertebral fracture that were confirmed by medical record review and diagnosed during the 6 years of follow-up between and May 31, Participants with a history of hip or wrist fracture at baseline were excluded from the analysis.
Statistical analysis Patient data, including smoking status, diabetes mellitus, body mass index BMIwalking ability, status of living in geriatric long stay facility or nursing homes vs. When judged useful, C-statistics for building receiving operator characteristic ROC curve was also used, in order to ascertain the optimal cut-off provided with the best balance between sensitivity and specificity, in the case of quantitative exposure variables that had been recognized to exert a role as predictive factors for vertebral fractures in hypertensive elderly women treated with thiazide diuretics.
Based on this categorization, three serum sodium classes were identified, i. This distinction was made to ascertain whether higher severity of hyponatremia was associated with a proportionately greater risk of newly diagnosed osteoporotic vertebral fractures.
The exposure variables entered in the model were age, BMI, thiazide-induced hyponatremia, smoking status, walking ability, status of living in geriatric long stay facility and diabetes mellitus.