LOOP DIURETICS










































Bumetanide vs Placebo for BMD Changes in Women with Osteopenia, J of Bone and Mineral Res (2006) [PubMed abstract]
  • The trial enrolled 87 postmenopausal women with osteopenia
Main inclusion criteria
  • > 50 years old
  • > 12 months since last menses
  • Osteopenia at lumbar spine or total hip
Main exclusion criteria
  • Hypo- or hyperthyroidism within last 5 years
  • Diuretic treatment within last 3 months
  • Received treatment with corticosteroids, anticonvulsants, NSAIDs, bisphosphonates, estrogen, or raloxifene in last 2 years
Baseline characteristics
  • Average age 66 years
  • Median T-score lumbar spine -1.7
  • Median T-score total hip -1.4
  • Taking calcium supplements ∼ 41%
Randomized treatment groups
  • Group 1 (46 patients) - Bumetanide 2 mg once daily
  • Group 2 (41 patients) - Placebo once daily
  • All patients took calcium 800 mg + cholecalciferol 10 mcg throughout the study
  • Bumetanide 2 mg is considered equivalent to furosemide 80 mg
Primary outcome: Percentage change at week 52 from baseline in BMD at the lumbar spine and total hip
Results

Duration: 52 weeks
Outcome Bumetanide Placebo Comparisons
Primary outcome (lumbar spine) -0.69% +0.26% p=0.08
Primary outcome (total hip) -1.61% +0.32% p=0.003
Plasma PTH levels (% change) +5.6% -3.0% p=0.003
Urinary calcium excretion (% change) +44% +26% p<0.01

Findings: Treatment with loop diuretics affects bone turnover and decreases BMD. Further studies may reveal whether loop diuretics should be considered as a risk factor for fracture.





























Drug Peak effect Duration of effect
Furosemide 1 - 2 hours 6 - 8 hours
Bumetanide 1 - 2 hours 4 - 6 hours
Torsemide 1 - 2 hours 6 - 8 hours