Prolonged loop diuretics increase postmenopausal fracture risk

Postmenopausal women who use loop diuretics are at increased risk of fractures, according to a report published in the Jan. 26 issue of the Archives of Internal Medicine.

Laura D. Carbone, MD, of the University of Tennessee Health Science Center in Memphis, and colleagues conducted a study using data from the Women's Health Initiative on 133,855 women, of whom 3,411 used loop diuretics and 130,444 did not. They looked at the women’s risk of falls and fractures over a mean period of 7.7 years and analyzed data on baseline and 3-year bone mineral density for 300 users and 9,124 non-users of loop diuretics.

Women who had ever used loop diuretics were not at significantly increased risk of total, hip, and clinical vertebral fractures and falls, the data revealed. However, those who used loop diuretics for more than 3 years had a 16% higher risk of both clinical and total fractures, compared with non-users, the researchers report. There was no association between changes in bone mineral density and use of loop diuretics, the investigators found."The relationship of falls to medication use is complex. We hypothesized that loop diuretics might be positively associated with falls because they may cause orthostatic hypotension," the authors write. "Prolonged use of loop diuretics was associated with higher fracture risk in postmenopausal women." (Carbone reported grant support and honorarium from Procter & Gamble and honorariums from Merck, Novartis, and Aventis.)

Carbone LD, Johnson KC, Bush AJ, et al. Loop diuretic use and fracture in postmenopausal women: Findings from the Women's Health Initiative. Arch Intern Med. 2009;169:132-140.