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Statins and Fracture: Are All Variables Accounted For?
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In reporting their findings of an association between statin use and fracture risk reduction, Scranton et al1 acknowledged that they did not consider the use of thiazide diuretics as a confounding variable. In explaining why they did not statistically adjust for thiazide diuretic use, the authors erroneously state, "the evidence of their association is limited."1(p2011)
It is axiomatic that calcium is an essential component of bone mass and that in both men and women, homeostatic mechanisms for maintaining eucalcemia diminish with advancing age. Declines in the renal tubular reabsorption of calcium can lead to a negative calcium balance, secondary hyperparathyroidism, and osteoclast-mediated bone resorption.2 Thiazide diuretics have been unequivocally demonstrated to decrease the urinary excretion of calcium.3 Moreover, thiazides may improve intestinal calcium absorption and might even have direct effects on bone-forming osteoblasts.4-5 Several epidemiological, retrospective and randomized prospective studies have demonstrated increased lumbar spine and femoral bone mineral density . . . [Full Text of this Article]
AUTHOR INFORMATION
Jordan L. Geller, MD;
John S. Adams, MD
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