Old men who take loop diuretics to treat heart failure and high blood pressure may be at an increased risk of bone loss in the hip area, a new study has warned.
Loop diuretics increase the amount of calcium excreted in urine which may lead to bone damage over the long term. In fact loop diuretics have also been associated with an increased risk of hip and other fractures.
"Loop diuretics are one of the most commonly prescribed medications among older adults. However, there is uncertainty as to whether this increased fracture risk is attributable to negative effects on bone mineral density, fall-related mechanisms (e.g., dizziness and orthostasis [low blood pressure when standing up]), or associated comorbidities [co-occurring illnesses]," the authors wrote.
Led by Lionel S. Lim, M.D., M.P.H., of Griffin Hospital, Derby, Conn., the researchers examined 3,269 men age 65 and older (average age 72.7). At an initial examination between 2000 and 2002 and at a follow-up visit an average of 4.6 years later, the men answered questions about medication use and brought in containers for all medication taken during the past 30 days. Bone mineral density of the total hip and two subregions was also measured.
A total of 84 men continuously used loop diuretics between the two time periods, 181 used them intermittently and 3,004 did not use them. When the reserahcers adjusted for other related factors, the average annual rate of decline in total hip bone mineral density was found to be -0.33 percent in non-users, -0.58 percent in intermittent users and -0.78 percent among continuous users.
"Compared with rates of hip bone loss among non-users of diuretics, adjusted rates of loss were about two-fold greater among intermittent loop diuretic users and about 2.5-fold greater among continuous loop diuretic users," the authors wrote.
The findings were similar at the subregions of the hip, and they added by saying: "We conclude that loop diuretic use in older men in associated with increased rates of hip bone loss. Our findings suggest that health care providers should take into account loop diuretic use when evaluating older men for risk factors for bone loss and fracture risk."
The study was published in the recent issue of Archives of Internal Medicine, one of the JAMA/Archives journals.