What is the mechanism by which thiazide diuretics affect bone mineral density?
Thiazide diuretics stimulate the distal tubular reabsorption of calcium to decrease urinary calcium excretion and positively affect bone mineral density. Other mechanisms that have been suggested by animal studies are an increase in calcium uptake by intestinal cells (1) and stimulation of osteoblast differentiation (2).
- Bazzini C, Vezzoli V, et al. Thiazide-sensitive NaCl-cotransporter in the intestine: possible role of hydrochlorothiazide in the intestinal Ca2+ uptake. Journal of Biological Chemistry 2005; 208(20): 19902-19910.
- Dvorak MM, De Joussineau C, Carter DH, et al. Thiazide diuretics directly induce osteoblast differentiation and mineralized nodule formation by interacting with a sodium chloride co-transporter in bone. J AM Soc Nephrol 2007; 18: 2509-16.