Thiazide diuretics and the risk for hip fracture.
BACKGROUND
Since most hip fractures are related to osteoporosis, treating accelerated bone loss can be an important strategy to prevent hip fractures. Thiazides have been associated with reduced age-related bone loss by decreasing urinary calcium excretion.


OBJECTIVE
To examine the association between dose and duration of thiazide diuretic use and the risk for hip fracture and to study the consequences of discontinuing use.


METHODS
Prospective population-based cohort study.


METHODS
The Rotterdam Study.


METHODS
7891 individuals 55 years of age and older.


METHODS
Hip fractures were reported by the general practitioners and verified by trained research assistants. Details of all dispensed drugs were available on a day-to-day basis. Exposure to thiazides was divided into 7 mutually exclusive categories: never use, current use for 1 to 42 days, current use for 43 to 365 days, current use for more than 365 days, discontinuation of use since 1 to 60 days, discontinuation of use since 61 to 120 days, and discontinuation of use since more than 120 days.


RESULTS
281 hip fractures occurred. Relative to nonuse, current use of thiazides for more than 365 days was statistically significantly associated with a lower risk for hip fracture (hazard ratio, 0.46 [95% CI, 0.21 to 0.96]). There was no clear dose dependency. This lower risk disappeared approximately 4 months after thiazide use was discontinued.


CONCLUSIONS
Thiazide diuretics protect against hip fracture, but this protective effect disappears within 4 months after use is discontinued.
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001581:Benzothiadiazines; D015519:Bone Density; D002118:Calcium / Q000652:urine; D002136:Calcium, Dietary / Q000008:administration & dosage; D004232:Diuretics; D004334:Drug Administration Schedule; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D049993:Sodium Chloride Symporter Inhibitors / Q000008:administration & dosage*
D001581:Benzothiadiazines; D002136:Calcium, Dietary; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D002118:Calcium