Dawson-Hughes B, Harris S
USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111.
Bone Miner. 1993 Apr;21(1):41-51. doi: 10.1016/s0169-6009(08)80119-5.
Thiazide diuretic use has been associated with reduced rates of bone loss and bone density has been found to fluctuate with time of year. Here we examine associations between thiazide use, calcium regulating hormones, and the pattern of bone change during the 6-month intervals of summer/fall when bone density increases and winter/spring when bone density declines. Of the 246 postmenopausal women who completed a 1-year calcium and vitamin D supplement trial, 25 used a thiazide diuretic. In the winter/spring, bone loss was reduced in the thiazide users (for L2-4: 0.46 +/- 0.59 (SE)% for thiazide users vs. -1.02 +/- 0.17% for non-users, P = 0.017; for whole-body: -0.13 +/- 0.25% vs. -0.67 +/- 0.08, P = 0.043). The benefit at the whole body was dose related. Increases in bone density were similar in the two groups in the summer/fall. Associations between thiazide use and net spinal change and between thiazide dose and net whole-body bone change were positive. Thiazide users had lower serum levels of PTH (26.2 +/- 7.6 (SD) ng/l vs. 31.0 +/- 11.7 ng/l, P = 0.009) and 1,25-dihydroxyvitamin D (60.8 +/- 16.2 pmol/l vs. 77.0 +/- 18.7 pmol/l, P < 0.001) in the winter/spring and, in the subset measured, reduced levels of osteocalcin year round (summer/fall: 2.89 +/- 0.82 micrograms/l, n = 10, vs. 3.65 +/- 1.02, n = 82, P = 0.019; winter/spring: 2.54 +/- 0.80 micrograms/l vs. 3.47 +/- 1.07 micrograms/l, P = 0.005). Sodium excretion in the two groups did not differ in the winter/spring. In conclusion, beneficial bone effects of thiazide diuretics occur in the winter/spring and they may result from a decrease in PTH-stimulated bone resorption and an associated reduction in the bone turnover rate.
噻嗪类利尿剂的使用与骨量流失率降低有关，且已发现骨密度会随季节波动。在此，我们研究了在骨密度增加的夏末秋初6个月期间以及骨密度下降的冬春季节，噻嗪类药物使用、钙调节激素与骨变化模式之间的关联。在完成了为期1年的钙和维生素D补充试验的246名绝经后女性中，25人使用了噻嗪类利尿剂。在冬春季节，噻嗪类药物使用者的骨量流失减少（L2 - 4部位：噻嗪类药物使用者为0.46±0.59（标准误）%，非使用者为 - 1.02±0.17%，P = 0.017；全身部位： - 0.13±0.25% 对比 - 0.67±0.08，P = 0.043）。全身的益处与剂量相关。在夏末秋初，两组的骨密度增加情况相似。噻嗪类药物使用与脊柱净变化之间以及噻嗪类药物剂量与全身骨净变化之间的关联为正相关。在冬春季节，噻嗪类药物使用者的血清甲状旁腺激素（PTH）水平较低（26.2±7.6（标准差）ng/l 对比 31.0±11.7 ng/l，P = 0.009）以及1,25 - 二羟基维生素D水平较低（60.8±16.2 pmol/l 对比 77.0±18.7 pmol/l，P < 0.001），并且在全年测量的子集中，骨钙素水平均降低（夏末秋初：2.89±0.82微克/升，n = 10，对比 3.65±1.02，n = 82，P = 0.019；冬春季节：2.54±0.80微克/升 对比 3.47±1.07微克/升，P = 0.005）。在冬春季节，两组的钠排泄无差异。总之，噻嗪类利尿剂对骨骼的有益作用发生在冬春季节，可能是由于PTH刺激的骨吸收减少以及骨转换率相应降低所致。
