Rapid Response

Thiazides and Osteoporosis: An Addition to the Armamentarium?

Authors: Ronald C. Hamdy, MD

Abstract

Thiazides and Osteoporosis: An Addition to the Armamentarium?


The use of thiazides in the management of osteoporosis should receive renewed interest. Thiazides inhibit the Na+-Cl− cotransporter system in the distal convoluted renal tubules, thereby increasing renal sodium excretion and decreasing renal calcium loss.1 They also increase the alkalinity of the bone resorption milieu, thus inhibiting the osteoclasts2 and, in addition, reduce osteoclast differentiation.3 In the above-referenced article, Dvorak et al, through a series of elegant experiments, have demonstrated that thiazides also interact directly with osteoblast Na+-Cl− cotransporter protein and promote bone formation. Thiazides therefore have a dual direct action on bone cells; inhibiting the osteoclasts and therefore bone resorption, and stimulating the osteoblasts and therefore bone formation. This dual action, combined with the reduced renal calcium loss, should make thiazides useful in the management of osteoporosis.

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