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Letters |

Thiazide Use and Reduced Sodium Intake for Prevention of Osteoporosis—Reply

Anne Klibanski, MD
JAMA. 2001;285(18):2323-2324. doi:10.1001/jama.285.18.2323.
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In Reply: Dr Bobrow and Dr Cappuccio highlight the important relationship between sodium and calcium balance with respect to bone density. Thiazide diuretics lower urinary calcium excretion, and several studies have reported increased bone density and decreased fracture risk in patients treated with thiazides. The 1983 cross-sectional study by Wasnich et al1 found a positive effect of thiazide use on bone density. A protective effect on hip fracture in older men and women receiving thiazides has also been shown. However, the recommended use of thiazides in normotensive individuals to prevent fractures warrants separate consideration. The most compelling data in this regard were not published until after the March 2000 Consensus Conference.2 A protective effect of low-dose thiazides on bone mineral density in this study was observed in normotensive women and men aged 60 years or older. This is the only such large randomized, placebo-controlled trial. However, specific recommendations as to the clinical role of thiazides in osteoporosis prevention remain to be determined.

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