Diuretics: Hydrochlorothiazide Preserves Bone Density: Large epidemiologic studies, including the Nurses’ Health Study, indicate that people treated with thiazide diuretics have higher bone mineral density (BMD) than those who don’t take them, and an approximately 30% lower risk of hip fracture. In a 3-year DB PC study of 320 healthy, normotensive men and women (aged 60 to 79) to hydrochlorothiazide, either 12.5 or 25 mg/day, led to gains in BMD at the hip of about 0.5% to 0.6% from baseline vs. a decrease of 0.3% for placebo. Spinal BMD was not significantly different. Ann Intern Med. 2000;133:516-26. 

Diuretics: Thiazides Decrease Fractures: In an 8 year follow-up study of 7,891 older adults, those using a thiazide blood pressure medication for more than 1 year were 54% less likely to sustain a hip fracture. There were no clear dose-response trends. Protective effects, caused by reducing calcium excretion, disappear about 4 months after such drugs were stopped. Bruno H. Ch. Stricker, Erasmus MC in Rotterdam, Ann Intern Med 2003;139:476-482.

Indapamide SR Did Best: In a metanalysis of 72 studies of hypertensive medications since 1973 comparing hydrochlorothiazide, indapamide sustained release (SR), furosemide and spironolactone for diuretics; amlodipine and lercanidipine for calcium channel antagonists; atenolol for beta-adrenoceptor antagonists (beta-blockers); enalapril and ramipril for ACE inhibitors; and candesartan cilexetil, irbesartan, losartan, and valsartan for angiotensin II receptor antagonists, indapamide was most successful at reducing systolic hypertension: 22 mmHg in the first 2-3 months. Baguet JP, Robitail S, et al. Grenoble University. Am J Cardiovasc Drugs. 2005;5(2):131-40

Thomas E. Radecki, M.D., J.D.

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