Do Vitamin D Level and Dietary Calcium Intake Modify the Association Between Loop Diuretics and Bone Health?

Abstract

Loop diuretics (LD) may affect bone health by inhibiting renal calcium reuptake. However, whether vitamin D status and dietary calcium intake modify the association between LD and bone outcome is unclear. Therefore, this study aimed to evaluate whether vitamin D level or calcium intake modify the association between LD and various indices of bone health including bone mineral density (BMD) and Trabecular Bone Score (TBS). From The Rotterdam Study, a prospective population-based cohort study, we used data from 6990 participants aged > 45 year with a DXA scan (2002-2008), 6908 participants with femoral neck (FN)-BMD, 6677 participants with lumbar spine (LS)-BMD and 6476 participants with LS-TBS measurements. Use of LD was available from pharmacy dispensing records. Vitamin D (25(OH)D) level was measured in serum, and dietary calcium intake was measured with a validated food frequency questionnaire. Almost eight percent of the participants used LD. The association between LD (past-users compared to never-users) and LS-TBS was significantly different by 25(OH) D concentrations (P for interaction = 0.04). A significantly lower LS-TBS among LD past-users was observed for 25(OH) D ≥ 50 nmol/l compared to ≤ 20 and 20-50 nmol/l (β = − 0.036, 95% CI − 0.060; − 0.013 vs. β = − 0.012, 95% CI − 0.036; 0.013 and β = − 0.031, 95% CI − 0.096; 0.034, respectively). However, no other significant effect modification by 25(OH)D and dietary calcium intake was found in the associations between LD use and bone health outcomes (P-interaction > 0.13). This study suggests that the association between LD use and indices of bone health is not consistently modified by vitamin D or dietary calcium intake.

The Effects of Osteoporotic and Non-osteoporotic Medications on Fracture Risk and Bone Mineral Density

“…However, no association between loop diuretics and BMD was found in two other observational studies [ 265 , 266 ]. Furthermore, a population-based cohort study showed that past use of loop diuretics was associated with higher lumbar spine BMD compared to never use, while no significant association between current use and lumbar spine BMD was found [ 267 ]. However, when studying the duration of use, a positive association between current use of loop diuretics and lumbar spine BMD was found in participants using the medications for a duration of use between 121 and 365 days.…”

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

“…For example, thiazolidinediones demonstrate detrimental effect on the skeleton and increase fracture risk [ 545 , 599 , 600 , 601 , 602 , 603 , 604 ] but a beneficial effect on muscle atrophy [ 605 ]; other anti-diabetic drugs (sulfonylureas, metformin and possible incretin mimetics) have a neutral or a positive/protective effect on bone health, but they may increase propensity for falls through hypoglycemia (insulin and sulfonylureas) [ 601 , 603 , 604 , 606 ]. When analyzing the complex relationships between OFs and drugs used it should also be taken into account that many medications (corticosteroids, sulfonamides, urea derivatives, vitamin K antagonists, cardiac glycosides, loop diuretics, potassium-sparing diuretics, ACE inhibitors, serotonin reuptake inhibitors, calcium-channel blockers and antiepileptic drugs) may affect the vitamin D status and calcium homeostasis [ 607 , 608 , 609 , 610 , 611 ]. Importantly, even in diseases inversely associated with HPI the abovementioned drugs may contribute to OP and/or falls and should be used with caution, especially in individuals with high fracture risk.…”

Dietary macrominerals: Updated review of their role and orchestration in human nutrition throughout the life cycle with sex differences

“…An adequate dietary calcium intake has been associated not only with the prevention of hypertension during pregnancy but also with the reduction of low-density lipoprotein (LDL), cholesterol levels and prevention of osteoporosis and colorectal adenomas ( Cormick and Belizan, 2019 ). However, the benefits of calcium supplementation on bone health seem to be greater in children and adolescents with higher needs of calcium intake ( Oliai Araghi et al, 2020 ). Owing to the serious consequences of hypertension in pregnancy, several studies have targeted to decrease the development of pre-eclampsia in pregnant women during their first couple of weeks of pregnancy.…”