I ABSOLUTELY recommend treating! This is the sine qua non of secondary osteoporosis with the osteoporosis being a direct consequence of the underlying hypercalciuria. Thiazides are great in this setting. I use chlorthalidone in preference to HCTZ because it has a longer half-life and can be used onc...

I agree it is imperative to check for and treat any secondary causes of low bone mass. I often find hypercalciuria (in patients not taking excessive oral calcium) but in cases without secondary hyperparathyroidism, I have not seen great improvements with Thiazides. Do you use iPTH as a means to d...