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Letters |

Thiazide Use and Reduced Sodium Intake for Prevention of Osteoporosis

Francesco P. Cappuccio, MD, FRCP, MFPHM
JAMA. 2001;285(18):2323-2324. doi:10.1001/jama.285.18.2323.
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To the Editor: The recent NIH Consensus Statement on osteoporosis1 acknowledges the risk of low bone mineral density for osteoporosis in all populations and at all ages. However, it fails to mention other preventive strategies that could reduce the incidence of osteoporosis. The article incompletely reviews and then dismisses evidence that high sodium intake (as seen in the United States and Europe) can lead to significant calcium losses compatible with bone demineralization over time.2,3 At least in the short term, a moderate reduction in sodium intake (to about 80-100 mmol per day) significantly reduces calcium losses and positively influences calcium balance and biomarkers of bone turnover, similar to the effects of thiazide diuretics.2,3 One panelist's report states that ". . . the degree of reduction in sodium intake required to protect the skeleton at contemporary calcium intake is probably not realistically achievable, and it is far easier to solve the problem by increasing calcium intake."4 The feasibility of a moderate reduction in sodium intake has been recently confirmed in the NIH-sponsored Dietary Approaches to Stop Hypertension (DASH) study.5 This strategy is also supported by the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (which included members of the NIH) recommending that the US population reduce sodium intake to no more than 100 mmol per day to prevent hypertension.6 That committee also accepted the evidence of a possible beneficial effect of a reduction in sodium intake on the incidence of osteoporosis. Therefore, the positions of the NIH and the National Heart, Lung, and Blood Institute on this matter appear to be inconsistent.

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