Letters to the Editor

Discussion of Protective Effects of Hydrochlorothiazide


Am Fam Physician. 2005 Jul 1;72(01).

to the editor: I am grateful for the thorough review of osteoporosis in the article “Pharmacologic Prevention of Osteoporotic Fractures,”1 that appeared in American Family Physician. However, there was no mention of the possible protective effects of hydrochlorothiazide (HydroDIURIL). Numerous references2-4 are available that cite increased bone density of patients receiving this medication, which is likely a result of its inhibition of calciuria.

Retrospective control-matched studies suggest a lowering of hip fracture incidence with the use of this medication.3,5 However, we will probably never see an example of the gold standard placebo-controlled, double-blind study for this medication, because nobody will ever make any money as a result of conducting such a study. Nevertheless, the evidence is there, the medication is inexpensive, and this information deserves at least a mention in a review article1 of this kind.


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1. Zizic TM. Pharmacologic prevention of osteoporotic fractures. Am Fam Physician 2004;70:1293-300. ...

2. LaCroix AZ, Ott SM, Ichikawa L, Scholes D, Barlow WE. Low-dose hydrochlorothiazide and preservation of bone mineral density in older adults. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2000;133:516-26.

3. Cauley JA, Cummings SR, Seeley DG, Black D, Browner W, Kuller LH, et al. Effects of thiazide diuretic therapy on bone mass, fractures, and falls. Ann Intern Med 1993;118:666-73.

4. Sigurdsson G, Franzson L. Increased bone mineral density in a population-based group of 70-year-old women on thiazide diuretics, independent of parathyroid hormone levels. J Intern Med 2001;250:51-6.

5. Schoofs MW, van der Klift M, Hofman A, de Laet CE, Herings RM, Stijnen T, et al. Thiazide diuretics and the risk for hip fracture. Ann Intern Med 2003;139:476-82.

in reply: Dr. Wagman’s points concerning the ability of hydrochlorothiazide to increase bone mineral density are relevant. Retrospective, control-matched studies do suggest a lowering of hip fracture incidence with the use of thiazide diuretics. However, the purpose of our article1 was not to provide an in-depth examination of the full gamut of treatments for osteoporosis, but rather to focus on the most relevant treatment options.


1. Zizic TM. Pharmacologic prevention of osteoporotic fractures. Am Fam Physician 2004;70:1293-300.

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