Loop diuretics (LD) may afect bone health by inhibiting renal calcium reuptake. However, whether vitamin D status and dietary calcium intake modify the association between LD and bone outcome is unclear. Therefore, this study aimed to evaluate whether vitamin D level or calcium intake modify the association between LD and various indices of bone health including bone mineral density (BMD) and Trabecular Bone Score (TBS). From The Rotterdam Study, a prospective population-based cohort study, we used data from 6990 participants aged >45 year with a DXA scan (2002–2008), 6908 participants with femoral neck (FN)-BMD, 6677 participants with lumbar spine (LS)-BMD and 6476 participants with LS-TBS measurements. Use of LD was available from pharmacy dispensing records. Vitamin D (25(OH)D) level was measured in serum, and dietary calcium intake was measured with a validated food frequency questionnaire. Almost eight percent of the participants used LD. The association between LD (past-users compared to never-users) and LS-TBS was signifcantly diferent by 25(OH) D concentrations (P for interaction=0.04). A signifcantly lower LS-TBS among LD past-users was observed for 25(OH) D ≥50 nmol/l compared to ≤20 and 20–50 nmol/l (β=−0.036, 95% CI −0.060; −0.013 vs. β=−0.012, 95% CI −0.036; 0.013 and β=−0.031, 95% CI −0.096; 0.034, respectively). However, no other signifcant efect modifcation by 25(OH)D and dietary calcium intake was found in the associations between LD use and bone health outcomes (P-interaction>0.13). This study suggests that the association between LD use and indices of bone health is not consistently modifed by vitamin D or dietary calcium intake.

Additional Metadata
Keywords Loop diuretics · Bone mineral density · Bone geometry · Trabecular Bone Score
Persistent URL dx.doi.org/10.1007/s00223-019-00621-1, hdl.handle.net/1765/120464
Journal Calcified Tissue International
Citation
Araghi, SO, de Jong, J.C, Trajanoska, K., Koromani, F., Rivadeneira Ramirez, F, Zillikens, M.C, … van der Velde, N. (2019). Do Vitamin D Level and Dietary Calcium Intake Modify the Association Between Loop Diuretics and Bone Health?. Calcified Tissue International. doi:10.1007/s00223-019-00621-1