Diuretic use and bone mineral density in older USA men: The osteoporotic fractures in men (MrOS) study [4]

University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Age and Ageing (Impact Factor: 3.64). 10/2005; 34(5):504-7. DOI: 10.1093/ageing/afi133
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    • "More recently, it was shown that administration of 1,25OH2D partially restored TH expression in the nigra of 6-hydroxydopamine lesioned rats [38]. Altering concentrations of 25(OH)D and/or 1,25OH2D could be protective by several distinct mechanisms, including stimulating the action of growth factors, acting as an antioxidant, or increasing glutathione production [17], [35], [39], [40]. Interestingly, we did not find the inverse, i.e., that short term 25(OH)D depletion (for eight weeks) made dopaminergic nigral neurons more susceptible to insult by MPTP. "
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    ABSTRACT: Recent clinical evidence supports a link between 25-hydroxyvitamin D insufficiency (serum 25-hydroxyvitamin D [25(OH)D] levels <30 ng/mL) and Parkinson's disease. To investigate the effect of 25(OH)D depletion on neuronal susceptibility to toxic insult, we induced a state of 25(OH)D deficiency in mice and then challenged them with the dopaminergic neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). We found there was no significant difference between control and 25(OH)D-deficient animals in striatal dopamine levels or dopamine transporter and tyrosine hydroxylase expression after lesioning with MPTP. Additionally, we found no difference in tyrosine hydroxylase expression in the substantia nigra pars compacta. Our data suggest that reducing 25(OH)D serum levels in mice has no effect on the vulnerability of nigral dopaminergic neurons in vivo in this model system of parkinsonism.
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    ABSTRACT: Low vitamin D status is recognized as a prevalent disorder in certain high-risk groups. The greatest prevalence has been reported in the institutionalized elderly. The goal of this article is to review the literature pertaining to vitamin D deficiency in the institutionalized elderly and to highlight the need for treatment in this high-risk group. A computer search for English language articles from 1980 to February 2007 was conducted using the PubMed database and key words vitamin D, hyperparathyroidism, elderly, institutionalization, and nursing home. Several risk factors have been noted, which are more prominent in the institutionalized elderly, including decreased sun exposure, poor oral intake, and multiple comorbidities. Long-term care residents should be prescribed higher doses of calcium and vitamin D for adequate bone mineral density and fracture prevention.
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    ABSTRACT: Older adults commonly use loop diuretics, which can increase urinary calcium excretion, leading to potential bone loss. Studies examining the association between loop diuretics and bone mineral density (BMD) are lacking, particularly those involving men. In this cohort study, we ascertained medication use (interviewer-administered questionnaire verified with inspection of medication containers) and measured the BMD of the total hip and 2 subregions (by dual-energy x-ray absorptiometry) at baseline and at a second visit an average of 4.6 years later among 3269 men aged 65 years and older. Eighty-four men were categorized as continuous users of loop diuretics, 181 as intermittent users of loop diuretics, and 3004 men as nonusers of loop diuretics. After adjustment for age, baseline BMD, body mass index, weight change from baseline, physical activity,clinic site, perceived health status, cigarette smoking status, diabetes mellitus, chronic obstructive pulmonary disease, congestive heart failure, hypertension, and statin use, the average annual rate of decline in total hip BMD steadily increased from -0.33% (95% confidence interval [CI], -0.36% to -0.31%) for nonusers,to -0.58% (95% CI, -0.69% to -0.47%) for intermittent users, and to -0.78% (95% CI, -0.96% to -0.60%)for continuous users. Findings were similar for change in BMD at the femoral neck and trochanter. We conclude that loop diuretic use in older men is associated with increased rates of hip bone loss. These results suggest that the potential for bone loss should be considered when loop diuretics are prescribed to older patients in clinical practice.
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