Loop diuretic use and rates of hip bone loss and risk of falls and fractures in older women

J Am Geriatr Soc. 2009 May;57(5):855-62. doi: 10.1111/j.1532-5415.2009.02195.x. Epub 2009 Apr 2.


Objectives: To determine whether loop diuretic use is associated with hip bone loss and greater risk of falls and fractures in older women.

Design: Prospective cohort study from August 1992 to April 2004.

Setting: Four regions in the United States from the Study of Osteoporotic Fractures (SOF).

Participants: Women aged 65 and older (N=8,127) with medication use data who participated in the fourth SOF examination, from which three study cohorts were derived.

Measurements: Bone mineral density (BMD) of the total hip assessed using dual-energy X-ray absorptiometry at the fourth and sixth examinations (n=2,980); recurrent (> or =2) falls in the year after the fourth examination (n=6,244); and incident fracture, including nonspine (n=6,778) and hip fracture (n=7,272).

Results: After multivariable adjustment, loop diuretic users had greater loss of total hip BMD than nonusers (mean annualized % BMD -0.87 vs -0.71, P=.03) after a mean of 4.4+/-0.6 years. The risks of recurrent falls (odds ratio=0.99, 95% confidence interval (CI)=0.71-1.39), nonspine (relative risk (RR)=1.04, 95% CI=0.90-1.21), and hip fracture (RR=1.03, 95% CI=0.81-1.31) were not greater in loop diuretic users than in nonusers.

Conclusion: In this cohort of older women, loop diuretic use was associated with a small but significantly higher rate of hip bone loss than nonuse after a mean duration of 4.4 years, although the risk of falls or fracture did not differ between the two groups.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Absorptiometry, Photon
  • Accidental Falls / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Bone Density / drug effects*
  • Female
  • Hip Fractures / epidemiology*
  • Hip Fractures / etiology
  • Humans
  • Least-Squares Analysis
  • Logistic Models
  • Pelvic Bones / pathology
  • Prospective Studies
  • Risk
  • Sodium Potassium Chloride Symporter Inhibitors / administration & dosage*
  • Sodium Potassium Chloride Symporter Inhibitors / adverse effects
  • United States / epidemiology


  • Sodium Potassium Chloride Symporter Inhibitors