Remodelage osseux et traitements diurétiques

Abstract

Loop diuretics and thiazides have opposite effects on renal calcium reabsorption. They might thereby have different consequences on bone metabolism. This review focuses on the clinical knowledge about bone remodelling under diuretic therapy, in terms of bone fracture and mineral density. Loop diuretics increase calcium renal excretion. Numerous case-control studies suggest that this class increases fracture risk. However, this has never been demonstrated in any prospective study. In fact, data on bone density from prospective studies or randomized trials suggest moderate bone loss at different sites. It is nevertheless difficult to attribute these findings to the drug itself, without taking into account the underlying disease that may share same risk factors with osteoporosis. Thiazides on the other hand, increase calcium renal reabsorption. Many studies (including prospective or randomized studies) show a reduction of fracture risk at different sites, as well as a gain in bone density. However these studies also included patients with various comorbidities and with various bone density status. The benefit of thiazides in osteoporotic patients who are correctly supplemented with calcium and vitamin D is still to be demonstrated.