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Low-Dose Diuretic To Preserve Bone Density in Older Adults
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What is the problem and what is known about it so far?
As people get older, their bones become less dense. When this bone thinning becomes severe, it is called osteoporosis. Persons with osteoporosis are at high risk for fractures, which can be a particularly serious problem at older ages. Previous studies have found that thiazide diuretics, a type of water pill, may increase bone density and may decrease the risk for hip fractures. Studies of this effect of thiazide diuretics have been limited in several ways, however, such as small size and inclusion of persons who were taking these medicines for reasons other than their effect on bone density (for example, high blood pressure).
Why did the researchers do this particular study?
To determine the effect of hydrochlorothiazide, a commonly used thiazide diuretic, on bone density in older adults.
Who was studied?
320 healthy adults 60 to 79 years of age with normal blood pressure (115 men and 205 women).
How was the study done?
The researchers randomly assigned study participants to take hydrochlorothiazide, 12.5 milligrams per day; hydrochlorothiazide, 25 milligrams per day; or placebo. The placebo pills looked like hydrochlorothiazide pills but contained no active ingredient. Before starting the study medication and every 6 months thereafter for the next 3 years, study participants underwent a special test to measure bone density of the hip, spine, and total body. Patients also completed surveys and examinations that provided information on general health, health behaviors that included diet and exercise, the occurrence of fractures, bone metabolism, and potential side effects of the study medicines.
What did the researchers find?
Three hundred nine of the 320 patients completed 3 years of the study. Bone density increased from baseline in patients who took hydrochlorothiazide compared with those who took placebo. In the total study group, bone density increased most in patients who took the higher dose of hydrochlorothiazide. The effects of thiazide were greater in women than in men. Side effects were relatively uncommon and occurred about equally in all three study groups.
What were the limitations of the study?
This study was too small and too short to determine whether the favorable bone density results were also associated with fewer fractures.
What are the implications of the study?
Among healthy older adults, hydrochlorothiazide preserves bone density. Further studies are needed to determine whether hydrochlorothiazide also prevents fractures.
Article and Author Information
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The summary below is from the full report titled “Low-Dose Hydrochlorothiazide and Preservation of Bone Mineral Density in Older Adults. A Randomized, Double-Blind, Placebo-Controlled Trial.” It is in the 3 October 2000 issue of Annals of Internal Medicine (volume 133, pages 516-526). The authors are AZ LaCroix, SM Ott, L Ichikawa, D Scholes, and WE Barlow.
- Copyright ©2004 by the American College of Physicians
