OsteoEd

Practice Cases

Thiazide Diuretics

Hayley Miller, MD & Heidi Powell, MD Literature reviewed September 01, 2008
A 57 year old healthy postmenopausal woman follows up in your clinic with her blood pressure readings. Most of her systolic pressures are between 140 and 150 and diastolic pressures are normal. You discuss the need to start medication. Her current meds: multivitamin, calcium and vitamin D. Family History: osteoporosis and breast cancer.

Click an answer under each question.

  1. Which antihypertensive agents have been shown in randomized controlled trials to increase bone density?

    • Option A Calcium channel blockers
    • Option B ARBs (angiotenisn receptor blockers)
    • Option C ACE (angiotensin converting enzyme) inhibitors
    • Option D Thiazide diuretics

  2. What is the mechanism by which thiazide diuretics affect bone mineral density?

    • Option A Thiazide directly stimulates osteoclasts
    • Option B Calcium reabsorbion by the kidneys increases
    • Option C Sodium absorption by the kidney increases
    • Option D Mechanism is not known

  3. How does thiazide use impact fracture risk?

    • Option A The few randomized controlled trials that have been done show a 10% or less decrease in fracture risk
    • Option B There is no evidence that it affects fracture risk based on observational studies
    • Option C Observational studies show that it decreases fracture risk, but randomized controlled trials have not been done
    • Option D It increases fracture risk slightly, despite increasing BMD

  4. She wants to know if there are any side effects from hydrochlorothiazide. You tell her that the medication is generally very well tolerated but it can have side effects. Which of the following are side effects of hydrochlorothiazide?

  5. The astute medical student assisting with the case inquires whether HCTZ is FDA approved for treatment of osteoporosis. You tell her:

    • Option A It is approved for severe osteoporosis but not osteopenia
    • Option B It is not approved for the treatment of bone disease
    • Option C It is approved for osteopenia but not osteoporosis
    • Option D It is currently in phase III trials for FDA approval
Key Points
Last edited September 11, 2008