Osteoporosis is a condition in which bones are weakened and are more likely to break. There are several known risk factors for developing osteoporosis such as sex, age, medical conditions, and some medications.1 Specifically, there have been reports of a correlation between diuretics and bone density concerns, including osteoporosis, though findings have been inconsistent.2
To understand the relationship between diuretics and bone density conditions, we studied 2,002,769 patients who were diagnosed with hypertension between January 1, 2017, and August 1, 2021, were treated with a diuretic, a calcium channel blocker, or both, and who had three years of follow-up care. Calcium channel blockers (CCBs) were selected as a subclass of medications that have been previously found to have no effect on bone density.2 We adjusted for age, sex, race, ethnicity, BMI, height, comorbidities, and Social Vulnerability Index score.
We found that the likelihood of being diagnosed with a bone density condition within three years of starting an antihypertensive medication varied greatly by which combination and number of medications a patient received, as seen in Figure 1. Those who were prescribed a thiazide and loop diuretic in addition to a CCB were 16% more likely to be diagnosed with a bone density condition compared to patients only on a CCB. Conversely, those on only a thiazide diuretic had a 4% reduced likelihood of developing a bone density condition compared to those on a CCB, while those on only a loop diuretic had a 6% reduced likelihood.
A sensitivity analysis assessing patients prescribed another blood pressure management medication, beta blockers, in place of calcium channel blockers as a control, showed similar results.
