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However, whether vitamin D status and dietary calcium intake modify the association between LD and bone outcome is unclear. Therefore, this study aimed to evaluate whether vitamin D level or calcium intake modify the association between LD and various indices of bone health including bone mineral density (BMD) and Trabecular Bone Score (TBS). From The Rotterdam Study, a prospective population-based cohort study, we used data from 6990 participants aged &gt;\u200945\u00a0year with a DXA scan (2002\u20132008), 6908 participants with femoral neck (FN)-BMD, 6677 participants with lumbar spine (LS)-BMD and 6476 participants with LS-TBS measurements. Use of LD was available from pharmacy dispensing records. Vitamin D (25(OH)D) level was measured in serum, and dietary calcium intake was measured with a validated food frequency questionnaire. Almost eight percent of the participants used LD. The association between LD (past-users compared to never-users) and LS-TBS was significantly different by 25(OH)D concentrations (<jats:italic>P<\/jats:italic> for interaction\u2009=\u20090.04). A significantly lower LS-TBS among LD past-users was observed for 25(OH)D \u2265\u200950\u00a0nmol\/l compared to \u2264\u200920 and 20\u201350\u00a0nmol\/l (<jats:italic>\u03b2<\/jats:italic>\u2009=\u2009\u2212\u20090.036, 95% CI \u2212\u20090.060; \u2212\u20090.013 vs. <jats:italic>\u03b2<\/jats:italic>\u2009=\u2009\u2212\u20090.012, 95% CI \u2212\u20090.036; 0.013 and \u03b2\u2009=\u2009\u2212\u20090.031, 95% CI \u2212\u20090.096; 0.034, respectively). However, no other significant effect modification by 25(OH)D and dietary calcium intake was found in the associations between LD use and bone health outcomes (<jats:italic>P<\/jats:italic>-interaction\u2009&gt;\u20090.13). This study suggests that the association between LD use and indices of bone health is not consistently modified by vitamin D or dietary calcium intake.<\/jats:p>","DOI":"10.1007\/s00223-019-00621-1","type":"journal-article","created":{"date-parts":[[2019,10,14]],"date-time":"2019-10-14T04:31:18Z","timestamp":1571027478000},"page":"104-114","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Do Vitamin D Level and Dietary Calcium Intake Modify the Association Between Loop Diuretics and Bone Health?"],"prefix":"10.1007","volume":"106","author":[{"given":"Sadaf","family":"Oliai Araghi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica C.","family":"Kiefte-de Jong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katerina","family":"Trajanoska","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fjorda","family":"Koromani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Rivadeneira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. 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