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.