Dear Editor,
I thank Dede et al. for their comprehensive review on the treatment of thalassemia-associated osteoporosis, noting the high prevalence of hypercalciuria and nephrolithiasis, and the association of the latter with lower femoral neck bone density and higher fracture rates in male patients [1]. A recent study demonstrated hypercalciuria was present in 92% of individuals with thalassemia treated with deferasirox in a positive dose-dependent relationship [2]. Thiazide diuretic use reduces urine calcium loss and is associated with improved bone density and reduced risk of hip fracture in observational studies [3]. In individuals with hypercalciuria and osteopenia/osteoporosis, administration of a thiazide or indapamide with bisphosphonate therapy was associated with greater reduction in calciuria and greater improvement in bone density than with bisphosphonate therapy alone [4, 5]. Studies examining the efficacy of thiazide or thiazide-like diuretics alone or in combination with bisphosphonates in improving bone density and reducing the risk of nephrolithiasis and fracture in individuals with thalassemia and hypercalciuria would be worthwhile.
References
Dede AD, Trovas G, Chronopoulos E, Triantafyllopoulos IK, Dontas I, Papaioannou N, Tournis S (2016) Thalassemia-associated osteoporosis: a systematic review on treatment and brief overview of the disease. Osteoporosis Int 27:3409–3425. doi:10.1007/s00198-016-3719-z
Wong P, Polkinghorne K, Kerr PG, Doery JC, Gillespie MT, Larmour I, Fuller PJ, Bowden DK, Milat F (2016) Deferasirox at therapeutic doses is associated with dose-dependent hypercalciuria. Bone 85:55–58
Kruse C, Eiken P, Vestergaard P (2016) Continuous and long-term treatment is more important than dosage for the protective effect of thiazide use on bone metabolism and fracture risk. J Intern Med 279:110–122
Giusti A, Barone A, Pioli G, Girasole G, Siccardi V, Palummeri E, Bianchi G (2009) Alendronate and indapamide alone or in combination in the management of hypercalciuria associated with osteoporosis: a randomized controlled trial of two drugs and three treatments. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association 24:1472–1477
Arrabal-Polo MA, Arias-Santiago S, de Haro-Munoz T, Lopez-Ruiz A, Orgaz-Molina J, Gonzalez-Torres S, Zuluaga-Gomez A, Arrabal-Martin M (2013) Effects of aminobisphosphonates and thiazides in patients with osteopenia/osteoporosis, hypercalciuria, and recurring renal calcium lithiasis. Urology 81:731–737
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A response to these comments can be found at doi: 10.1007/s00198-17-3927-1.
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Morton, A. A role for thiazide diuretic therapy in preventing bone loss, fracture, and nephrolithiasis in individuals with thalassemia and hypercalciuria?. Osteoporos Int 28, 1759 (2017). https://doi.org/10.1007/s00198-017-3922-6
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DOI: https://doi.org/10.1007/s00198-017-3922-6