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.
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.