Sunday, September 2, 2012

Diuretics: Fracture Risk

There has been debate regarding the benefits or risks of using diuretic medications to reduce urine calcium loss in patients with osteoporosis. When I evaluate the literature, it is clear that diuretics for the treatment of osteoporosis is NOT the way to go. Diuretics not only appear to increase the risk of hip fractures due to their adverse effects on bone mineral density but they also increase urinary losses of vitamin B6, magnesium, potassium and zinc. This leads to low energy, metabolic acidosis and the increased risk for falls due to their adverse effects on a person's hemodynamics and equilibrium.

A study reported in Osteoporosis International (Berry et al., 2012) found "the risk of hip fracture was transiently elevated around twofold shortly after initiation of a loop or thiazide diuretic drug."

Although this study found no long term increase in hip fractures with the use of diuretics, a better alternative for reducing abnormally high urine calcium* loss is to increase fruit and vegetable intake to help neutralize the body's pH, and to supplement with vitamin K, potassium and boron. If you have excess calcium in your urine, try this plan: 1) increase fruits and vegetables to eight to ten servings a day, 2) eliminate high-phosphorus cola drinks, 3) moderate (or eliminate) your intake of red meats and avoid caffeine, 4) minimize your dairy intake (replace this calcium source with supplemental microcristalline hydroxyapatite or calcium citrate/malate--OsteoMineralBoost and OsteoSustain are perfect for this), and 5) supplement with Osteo-pHBalance our alkalinizing formula with potassium, spirulina and chlorella.

*Note: I frequently have patients tell me that their doctor prescribed them a diuretic in response to an abnormal result on their 24-hour urine calcium test. When asked if they refrained from taking calcium supplements before the test, they almost invariably report that they had not. If calcium supplements are taken during the collection of urine for this test, it will almost always return as abnormal (above 275 mg for women and 300 mg for men). To avoid erroneous test results, eat your regular diet and refrain from taking supplemental calcium for the 24 hours before and during the test.

Berry, S.D., Zhu, Y., Choi, H., Kiel, D.P., and Zhang, Y. 2012. Diuretic initiation and the acute risk of hip fracture. Osteoporosis Int DOI:10.1007/s00198-012-2053-3
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