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Published on: January 29, 2018

Bone mineral density in children with myelomeningocele: effect of hydrochlorothiazide

Albert Quan1, Richard Adams, Elaine Ekmark

  • 1Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9063, USA. albert.quan@utsouthwestern.edu

Pediatric Nephrology (Berlin, Germany)
|July 29, 2003
PubMed

Insights

Hydrochlorothiazide (HCTZ) reduced urinary calcium excretion in non-ambulatory children with myelomeningocele. However, this 1-year treatment did not significantly impact bone mineral density (BMD) in this patient group.

Area of Science:

  • Pediatric Endocrinology
  • Nephrology
  • Orthopedics

Background:

  • Myelomeningocele often causes ambulation difficulties, leading to immobilization and reduced bone mineral density (BMD).
  • Non-ambulatory patients with myelomeningocele exhibit higher urinary calcium losses compared to ambulatory individuals.
  • Hydrochlorothiazide (HCTZ) is recognized for reducing urinary calcium and increasing BMD in patients with hypercalciuria.

Purpose of the Study:

  • To investigate the efficacy of HCTZ in managing urinary calcium excretion and bone mineral density (BMD) in non-ambulatory children with myelomeningocele.

Main Methods:

  • A year-long, randomized, double-blind study involving 13 non-ambulatory myelomeningocele patients (6 HCTZ, 7 placebo).
  • Evaluated electrolytes, parathyroid hormone (PTH), osteocalcin, vitamin D levels, urinary calcium/creatinine (U(Ca/Cr)), and forearm BMD via dual X-ray absorptiometry.
  • Measurements were taken at baseline and 12 months, with interim electrolyte checks.

Main Results:

  • No significant baseline differences were observed between the HCTZ and placebo groups.
  • HCTZ treatment led to a significant reduction in urinary calcium/creatinine (U(Ca/Cr)) levels (p<0.05).
  • Forearm BMD (z-scores) remained stable and showed no significant change in either the HCTZ or placebo group after 1 year.

Conclusions:

  • Hydrochlorothiazide (HCTZ) effectively reduces urinary calcium excretion in non-ambulatory children with myelomeningocele.
  • One year of HCTZ treatment did not demonstrate a significant effect on bone mineral density (BMD) in this population.
  • Further research may explore long-term effects or alternative interventions for BMD in myelomeningocele patients.

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