Heart Failure Drugs Linked to Hip Bone Loss in Older Men

TUESDAY April 15, 2008 -- Loop diuretics, drugs commonly prescribed to treat heart failure and hypertension, increase the risk of hip bone loss in older men, says a U.S. study.

Researchers evaluated 3,269 men, aged 65 and older, who underwent an initial examination between 2000 and 2002, with a follow-up visit an average of 4.6 years later. They collected information about all the medications being taken by the men and checked bone mineral density in the men's hips.

Among the men in the study, 84 continuously used loop diuretics between the initial and follow-up examinations, 181 used the drugs intermittently, and 3,004 never used them. After adjusting for other factors, the researchers found that the average annual rate of decline in total hip bone mineral density was -0.78 among continuous users, -0.58 among intermittent users, and -0.33 among non-users.

"Compared with rates of hip bone loss among non-users of diuretics, adjusted rates of loss were about twofold greater among intermittent loop diuretic users and about 2.5-fold greater among continuous loop diuretic users," wrote Dr. Lionel S. Lim, of Griffin Hospital in Derby, Conn., and his colleagues.

"We conclude that loop diuretic use in older men is associated with increased rates of hip bone loss," wrote the authors, who said future research should examine the underlying mechanisms of this 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," they said.

The study was published in the April 14 issue of the Archives of Internal Medicine.

The researchers noted that loop diuretics are one of the most commonly prescribed medications among older adults. These drugs increase the amount of calcium excreted in urine, and long-term use may harm bones. Previous observational studies have found an association between the use of loop diuretics and increased risk of fractures.

But the researchers said there's been "uncertainty as to whether this increased fracture risk is attributable to negative effects on bone mineral density, fall-related mechanisms (e.g., dizziness and orthostatis [low blood pressure when standing up]), or associated comorbidities (co-occurring illnesses)."

More information

The U.S. Food and Drug Administration has more about diuretics and other drugs used to treat hypertension.

Posted: April 2008


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