Effect of thiazides on bone mineral density in children with idiopathic hypercalciuria

Abstract

To determine the effect of thiazide treatment on bone mineral density (BMD) in children with idiopathic hypercalciuria (IH) and osteopenia, we reviewed the case notes of 22 children aged 11.7 ± 2.7 years diagnosed with IH and osteopenia who had received thiazides for 2.4 years. The data on this group were compared with those of 32 IH children with osteopenia aged 11.2 ± 2.7 years who had not received thiazide treatment. By the end of the follow-up period, the z-BMD had improved spontaneously in 23 of the 32 control children (72%) and in 12 of the 22 patients on thiazides (54%). Although treated patients had a higher body mass index (BMI) and a higher BMD following treatment, the differences became statistically negligible when these parameters were expressed as z-BMD or as bone mineral apparent density (BMAD). In contrast, within the control group, there were significant differences in BMAD and z-BMD at the end of the follow-up. Patients who had an improved z-BMD at the end of the treatment also showed an increase in their BMI. Based on these results, we conclude that thiazide treatment does not improve the z-BMD in children with IH. More than half of the children suffering from IH enrolled in our study showed a spontaneous improvement in their z-BMD, which was more evident when the initial BMAD was not low and when their BMI increased during the follow-up period.

Treatment of idiopathic hypercalciuria and its impact on associated diseases

“…12 Besides, potassium citrate treatment was supported by the formation of citrate-calcium complexes in urine, with a reduction of ultrafiltrable ionic calcium. 13 Finally, and even though there are controversies in this respect, 14 hydrochlorothiazide was used to stimulate transcellular calcium transport if IH symptoms persisted, consistent with La Croix's experience. 15 In short, sequential therapy was found to be effective to manage IH and was related to a reduction of associated diseases.…”

Metaphylaxis in Pediatric Urinary Stone Disease

“…Thiazide-derived diuretics support bone density, even in patients with restricted calcium [63]. Studies have suggested that hydrochlorothiazide is beneicial to bone density in children with hypercalciuria, but this efect has been reported as limited in older children who are developing osteopenia [64,65]. Controlled studies with larger populations are needed, but early hydrochlorothiazide treatment appears to be favorable for bone growth.…”

Tratamiento de la hipercalciuria idiopática y su incidencia sobre las patologías asociadas

“…12 Por otra parte, el tratamiento con citrato de potasio se fundamentó en la formación de complejos citrato-calcio en la orina, con reducción del calcio iónico ultrafiltrable. 13 Finalmente, y aunque existen controversias al respecto, 14 frente a la persistencia sintomática de la HI, en concordancia con la experiencia de La Croix, empleamos hidroclorotiazida para estimular el transporte transcelular de calcio. 15 En conclusión, hallamos que el tratamiento secuencial fue eficaz para el control de la HI y se asoció con una reducción de las patologías asociadas.…”