Effect of thiazide on rates of bone mineral loss: a longitudinal study.

OBJECTIVE To determine the effect of thiazide diuretic drugs on rates of bone mineral loss. DESIGN Longitudinal, observational study with a mean follow up of five years. SETTING Hawaii Osteoporosis Center, Honolulu. SUBJECTS 1017 Japanese-American men born between 1900 and 1920, of whom 378 were treated for hypertension (study group) and 639 did not have hypertension (control group). INTERVENTION Thiazide diuretics were taken by 325 men for a mean of 11.9 years; 53 men took antihypertensive drugs other than thiazides. MAIN OUTCOME MEASURE Rate of bone loss estimated from serial photon absorptiometric scanning at three skeletal sites (calcaneus, distal radius, and proximal radius). RESULTS Rates of bone loss at all three sites were significantly reduced among thiazide users when compared with controls. The reductions in loss rate ranged from 28.8% (p = 0.02) (distal radius) to 49.2% (p = 0.0005) (calcaneus) relative to the controls. At all three sites the men taking other antihypertensive drugs had faster loss rates (22.6-43.1%) than those of the controls but the difference was significant only for the distal radius. CONCLUSION Thiazide diuretics slow the rate of bone loss in elderly men.