Calcified Tissue International

, Volume 98, Issue 5, pp 474–478

Relationship Between Changes in Serum Urate and Bone Mineral Density During Treatment with Thiazide Diuretics: Secondary Analysis from a Randomized Controlled Trial

  • Nicola Dalbeth
  • Gregory D. Gamble
  • Anne Horne
  • Ian R. Reid
Original Research


In observational studies, serum urate concentrations associate with bone mineral density (BMD) and reduced risk of fractures. Thiazide diuretics slow the bone loss in healthy older adults, are associated with reduced incidence of fracture and also increase serum urate. We hypothesized that changes in serum urate are associated with changes in BMD during treatment with thiazide diuretics. We analysed data from a double-blind randomized controlled trial of hydrochlorothiazide (50 mg per day) and placebo in normal post-menopausal women. The relationship between change in serum urate and change in BMD after 2 years of treatment was examined using Spearman correlation and multiple linear regression models. Total body BMD increased in the hydrochlorothiazide group by 0.52 % and reduced in the placebo group by 0.29 % over 2 years (between group difference P = 0.0034). Serum urate increased in the hydrochlorothiazide group by 0.038 mmol/L and reduced in the placebo group by 0.004 mmol/L (between group difference P < 0.0001). At Year 2, there was a positive relationship between the change in serum urate and change in total body BMD for entire study population (r = 0.32, P = 0.0002) and for the hydrochlorothiazide group (r = 0.29, P = 0.023). The association between change in serum urate and change in total body BMD persisted after adjusting for treatment allocation, and change in weight, serum calcium, urinary calcium and serum creatinine (Pchange in serum urate = 0.043). These data raise the possibility that the effects of hydrochlorothiazide on BMD may be mediated, in part, by changes in serum urate concentrations.


Urate Bone mineral density Thiazide Diuretic Randomized controlled trial 

Supplementary material

223_2015_101_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 15 kb)
223_2015_101_MOESM2_ESM.jpg (421 kb)
Scatter plots with regression lines showing relationship between change in serum urate and change in total BMD at Year 4. Closed dots and solid line refer to the thiazide group, and open dots and hashed line refer to the placebo group. Supplementary material 2 (JPEG 420 kb)


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Nicola Dalbeth
    • 1
  • Gregory D. Gamble
    • 1
  • Anne Horne
    • 1
  • Ian R. Reid
    • 1
  1. 1.Auckland Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand

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