We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
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.
Text Size: A A A
Published online


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.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.