The effect of treatment with a thiazide diuretic for 4 years on bone density in normal postmenopausal women

Osteoporos Int. 2007 Apr;18(4):479-86. doi: 10.1007/s00198-006-0259-y. Epub 2006 Nov 21.


Summary: We performed a 2-year extension of our previous 2-year randomized controlled trial of the effects of hydrochlorothiazide on bone mineral density. The improvements in bone density seen in the first 2 years were sustained throughout the extension study. Thiazides provide a further option in the prevention of postmenopausal bone loss.

Introduction: Thiazide diuretics reduce urinary calcium excretion and therefore might prevent osteoporosis. Previously we reported a 2-year randomized controlled trial of hydrochlorothiazide treatment in 185 postmenopausal women that showed positive benefits of hydrochlorothiazide on bone density. Here, we report the results of a 2-year extension to that study.

Methods: Of 185 healthy postmenopausal women, 122 agreed to continue in a double-blinded 2-year extension taking 50 mg hydrochlorothiazide or placebo daily. Measurements of bone density occurred every 6 months and of calcium metabolism at 2 and 4 years.

Results: The improvements in bone density seen in the first 2 years of the trial were sustained throughout the extension. There were significant between-groups differences in the change in bone density over 4 years at the total body (0.9%, P<0.001), legs (1.0%, P=0.002), mid-forearm (1.1%, P=0.03), and ultradistal forearm (1.4%, P=0.04). At the lumbar spine (0.9%, P=0.76) and femoral neck (0.4%, P=0.53) the between-groups differences did not reach statistical significance.

Conclusions: Hydrochlorothiazide produces small positive benefits on cortical bone density that are sustained for at least the first 4 years of treatment. They provide a further option in the prevention of postmenopausal bone loss, especially for women with hypertension or a history of kidney stones.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Blood Chemical Analysis / methods
  • Bone Density / drug effects*
  • Bone Resorption / physiopathology
  • Bone Resorption / prevention & control
  • Calcium / metabolism
  • Double-Blind Method
  • Female
  • Fractures, Bone / prevention & control
  • Humans
  • Hydrochlorothiazide / adverse effects
  • Hydrochlorothiazide / therapeutic use*
  • Leg Bones / physiology
  • Long-Term Care / methods
  • Middle Aged
  • Osteoporosis, Postmenopausal / prevention & control
  • Postmenopause / physiology*
  • Sodium Chloride Symporter Inhibitors / adverse effects
  • Sodium Chloride Symporter Inhibitors / therapeutic use*
  • Spine / physiology
  • Treatment Outcome


  • Sodium Chloride Symporter Inhibitors
  • Hydrochlorothiazide
  • Calcium