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Relationship Between Loop Diuretics and Fractures

Review on December 01, 2009

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After menopause, the woman's normal body functions may go. To combat symptoms of menopauses and diseases that may arise as a result of estrogen loss, many women turn to other treatments including hormone replacement therapy. Other medications are used in aging and post menopause women, including loop diuretics. As this is a common medication among older woman, a concern arose as to whether loop diuretics actually add to bone mineral density loss, fracture and fall in women who have undergone menopause. To determine this relationship, this study was conducted.

Just before and after menopause, the risk of osteoporosis and heart failure becomes a great health concern for women. Statistics show that half of the women who have experienced menopause will, at one point in their life, experience an osteoporosis - related fracture.

As this is a large scale issue in the health field, many studies are ongoing to determine preventative methods and to test if existing medications or treatments actually exemplify or increase the risks of osteoporosis and fracture in women.

In the United States alone, loop diuretics were included in the top 200 prescribed medications. Loop diuretics increase the amount of calcium excreted in the body. Hypercaliuria (elevated calcium excretion in urine) is associated with low bone mineral density which is a definite risk factor for fractures.

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In previous studies, the relationship between loop diuretics and bone mineral density, falls and fractures have been inconsistent. Using data from the Women's Health Initiative a study was conducted in women ages 50 to 79 enrolled in 40 different clinical centers, from October 29, 1993 to December 31, 1998. The participants were studied for loop diuretic use and changes in bone mineral density, falls and fractures. Of the 133,855 participants, 3,411 were loop diuretic users and 130,444 were nonusers.

Covariates

Certain adjustments were made for this study including medication use and use of dietary supplement use. Hormone therapy was defined as estrogen hormones with or without progesterone.

Questionnaires were used to collect information on age, ethnicity, parental history of hip fractures, fractures before or after the age of 55, age at menopause, smoking status, and history of coronary heart disease or coronary heart failure. Participants were also asked about history of diabetes, stroke, cancer and emphysema.

The results of this study showed that there are no significant associations found between loop diuretic use and falls, changes in bone mineral density or fractures in women who have gone through menopause. It was noticed that long term use of loop diuretics was related to a higher risk of fracture in women that had gone through menopause. Generally women that were in poor health and already at a higher risk for falls, fractures and bone mineral density loss were users of loop diuretics.

Sources:
  • MD Cobleigh, Melody A.; DO Norlock, Frances E. ; MPH PhD Oleske, Denise M.; Starr, Alexander. "Hormone Replacement Therapy and High S Phase in Breast Cancer"JAMA. 1999.