Summary

Loop diuretics are commonly used by patients with heart failure, but there is concern of the possible impact of these drugs upon bone health. Therefore, a study of this issue has been made within the Women's Health Initiative. Loop diuretics are not linked to decreased bone density, falls, or vertebral and hip fractures. Long term use does, however, increase the risk of other fractures.

Introduction

Both congestive heart failure and osteoporosis may affect postmenopausal women. Loop diuretics are a commonly used medication for the former. However, they do increase the excretion of calcium, so there is concern that they could have a negative impact on bone health - possibly thereby increasing the risk of osteoporosis, falls and fractures. However, there has been no large prospective study examining this possible relationship.

What was done

Researchers at the University of Tennessee carried out the current study as part of the Women's Health Initiative, which is a long-running study into women's health. They looked at 133, 855 postmenopausal women, of whom 3411 used loop diuretics. Bone mineral density measurements were noted, and all falls and fractures occurring during seven years of follow up were recorded.

What was found

Overall, there was no association between loop diuretic use and total fractures, hip fractures, vertebral fractures and falls. Nor was there any change in bone mineral density that could be attributed to loop diuretic use. However, women who were on loop diuretics for more than three years did have a small increased risk of other fractures and of total fractures.

What this study means

Women who need to take loop diuretics long term for a heart condition should be aware that a small risk to their bone health has now been demonstrated. Preventive measures may need to be taken to prevent fractures.

Source

Loop diuretic use and fracture in postmenopausal women
LD. Carbone, KC. Johnson,  et al, Archives of Internal Medicine, January 26 2009, vol. 169, pp. 132--140