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Effects of long-term treatment with loop diuretics on bone mineral density, calcitropic hormones and bone turnover

L Rejnmark1, P Vestergaard, L Heickendorff

  • 1Department of Endocrinology and Metabolism C, Aarhus Sygehus, Aarhus University Hospital, Aarhus, Denmark. rejnmark@post6.tele.dk

Journal of Internal Medicine
|January 20, 2005
PubMed

Insights

Loop diuretics (LD) increase calcium loss but maintain calcium balance through vitamin D regulation. Long-term LD use shows no negative impact on bone metabolism despite altered calcium homeostasis.

Area of Science:

  • Endocrinology
  • Nephrology
  • Bone Metabolism

Background:

  • Loop diuretics (LD) are commonly prescribed for cardiovascular conditions involving fluid retention.
  • LD are known to increase urinary calcium excretion, potentially impacting calcium homeostasis and bone health.

Purpose of the Study:

  • To investigate the long-term effects of loop diuretic treatment on calcium homeostasis and bone metabolism.

Main Methods:

  • A cross-sectional study comparing 140 postmenopausal women on long-term LD therapy with 140 age-matched controls.
  • Measurements included urinary calcium, plasma parathyroid hormone (PTH), 1,25-dihydroxyvitamin D, body composition, and bone mineral density (BMD).

Main Results:

  • LD users exhibited increased urinary calcium, plasma PTH, and 1,25-dihydroxyvitamin D.
  • Despite higher body weight and fat mass in LD users, BMD was initially higher, but normalized after adjusting for body weight.
  • Longer duration of LD treatment correlated positively with spinal BMD.

Conclusions:

  • Increased renal calcium losses from LD are counterbalanced by PTH-mediated increases in 1,25-dihydroxyvitamin D, maintaining neutral calcium balance.
  • Overall, long-term LD treatment does not appear to significantly impair bone metabolism.
Abstract

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