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 references^2–4 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.