Compared To Other Blood Pressure Medications Diuretics Have Bone Protective Effect Interview with:

Joshua I. Barzilay, MD Kaiser Permanente of Georgia Duluth, GA 30096

Dr. Joshua I. Barzilay

Joshua I. Barzilay, MD
Kaiser Permanente of Georgia
Duluth, GA 30096 What is the background for this study?

Response: Hypertension (HTN) and osteoporosis (OP) are age-related disorders. Both increase rapidly in prevalence after age 65 years. Prior retrospective, post hoc studies have suggested that thiazide diuretics may decrease the risk of osteoporosis. These studies, by their nature, are open to bias. Moreover, these studies have not examined the effects of other anti HTN medications on osteoporosis.

Here we used a prospective blood pressure study of ~5 years duration to examine the effects of a thiazide diuretic, a calcium channel blocker and an ACE inhibitor on hip and pelvic fractures. We chose these fractures since they are almost always associated with hospitalization and thus their occurrence can be verified.

After the conclusion of the study we added another several years of follow up by querying medicare data sets for hip and pelvic fractures in those participants with medicare coverage after the study conclusion. What are the main findings?

Response: We found that during the trial use of the thiazide-like diuretic chlorthalidone was associated with a more than 20% reduced risk of fracture than users of the other 2 medications. When we examined the calcium blocker and ACE inhibitor individually against the diuretic there was a more than 25% significant increased fracture risk with the ACE inhibitor. The risk was also increased with the calcium blocker but the difference was not statistically significant. What should readers take away from your report?

Response: When study findings were extended beyond the trial period – when use of anti-HTN medications was ad lib and people could be treated with any type of medication – there were no longer statistically significant differences in fracture risk BUT the people initially treated with the diuretic continued to have a lower risk of fractures than those initially treated with the other 2 medications. This suggests a legacy effect of diuretics on bone! Is there anything else you would like to add?

Response: Diuretics have a long proven track record for cardiovascular protection. Here we prospectively show that they also have a strong positive effect relative to other anti-hypertension medications for bone protection. This class of antihypertension medications has a lot going for it in terms of health for older adults! Thank you for your contribution to the community.


Puttnam R, Davis BR, Pressel SL, Whelton PK, Cushman WC, Louis GT, Margolis KL, Oparil S, Williamson J, Ghosh A, Einhorn PT, Barzilay JI, for the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Collaborative Research Group. Association of 3 Different Antihypertensive Medications With Hip and Pelvic Fracture Risk in Older AdultsSecondary Analysis of a Randomized Clinical Trial. JAMA Intern Med. Published online November 21, 2016. doi:10.1001/jamainternmed.2016.6821

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on November 22, 2016 by Marie Benz MD FAAD