Hydrochlorothiazide and Bone Mineral Density in Patients with Kidney Stones: Post Hoc Analysis of the NOSTONE Trial
Year: 2025
Type: article
Abstract: Key Points Loss of bone mineral density at 3 years was similar in patients with calcium kidney stones randomized to hydrochlorothiazide or placebo. There was no association between hydrochlorothiazide dose and change in bone mineral density at 3 years. Results were consistent across sensitivity and per-protocol analyses. Background Low bone mass and fractures are common among kidney stone formers, yet it remains unclear whether thiazides can help preserve bone mass. We aimed to evaluate the effectiveness of a range of hydrochlorothiazide (HCTZ) doses compared with a placebo on bone mineral density (BMD) over a 3-year period. Methods This post hoc analysis was conducted on data from the NOSTONE trial, a multicenter, randomized, controlled study. A total of 416 adults with recurrent calcium stones participated in the study, receiving either placebo or HCTZ at doses of 12.5, 25, or 50 mg daily. BMD was measured using computed tomography at the T12–L3 vertebrae at both baseline and the end of the study. Results Over a median follow-up period of 2.92 years, the mean BMD decreased by 6.4±15.7 Hounsfield units (HU) in the placebo group, 5.1±15.1 HU in the 12.5 mg HCTZ group ( β coefficient versus placebo, 0.37 HU; 95% confidence interval [CI], −1.74 to 2.47; P = 0.73), 4.1±16.3 HU in the 25 mg HCTZ group ( β , 0.93 HU; 95% CI, −1.34 to 3.19; P = 0.42), and 4.8±15.9 HU in the 50 mg HCTZ group ( β , 0.70 HU; 95% CI, −1.45 to 2.85; P = 0.52). No association was observed between HCTZ dose and BMD at the end of the study ( P = 0.43). The results were confirmed in sensitivity analyses for eGFR, urine calcium, net gastrointestinal alkali absorption, and body mass index; in subgroup; and in per-protocol analyses. Conclusions In patients with recurrent calcium kidney stones, loss of BMD was similar in patients receiving HCTZ at a dose of 12.5, 25, or 50 mg or placebo once daily. Clinical Trial registry name and registration number: NCT03057431.
Authors: Andreas Christe, Elias Primetis, Grazia M. Cereghetti, Dionysios Drakopoulos, Nasser A. Dhayat, Olivier Bonny, Alexander Ritter, Nilufar Mohebbi, Nicolas Faller, Lisa Pellegrini, Giulia Bedino, Reto M. Venzin, Philipp Grosse, Carina Hüsler, Irene Koneth, Christian Bucher, Rosaria Del Giorno, Luca Gabutti, Michael Mayr, Urs Odermatt, Florian Buchkremer, Thomas Ernandez, Catherine Stoermann-Chopard, Daniel Teta, Luca Tamò, Sven Trelle, Beat Roth, Matteo Bargagli, Daniel G. Fuster
Institutions: University of Bern, University Hospital of Bern, B. Braun (Switzerland), University of Fribourg, Centre Hospitalier Universitaire Vaudois, University of Lausanne, University Hospital Zurich, Ospedale regionale di Lugano, Kantonsspital Graubünden, Kantonsspital St. Gallen, Ospedale Regionale di Bellinzona e Valli, University of Basel, University Hospital of Basel, Luzerner Kantonsspital, Kantonsspital Aarau, University of Geneva, University Hospital of Geneva, Hôpital du Valais
Language: English
Subfield: Urology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4408288758