Use of alpha-blockers and the risk of hip/femur fractures.
OBJECTIVE
To study the association between use of alpha-blockers and risk of hip/femur fractures.


METHODS
Population-based case-control study.


METHODS
General Practice Research Database.


METHODS
Cases were defined as men, aged 40 years and older with a first diagnosis for hip/femur fracture. Controls were matched 1 : 1 on gender, year of birth and general practitioner-practice.


RESULTS
In all, 4571 cases and an equal number of controls were identified. Current use of alpha-blockers (prazosin, doxazosin, indoramin, terazosin, alfuzosin and tamsulosin) was compared with non-use of alpha-blockers. Current use of alpha-blockers on the index date was associated with an increased risk of hip/femur fracture [adjusted odds ratio (OR) 1.9, 95% confidence interval (CI): 1.1-3.0] in the overall analysis. The effect was particularly strong for first prescriptions within a treatment episode (adjusted OR 5.1, 95% CI: 1.0-31.7) and during the first month of treatment (adjusted OR 4.1, 95% CI: 0.7-23.9). Stratification according to indication of use showed that current use of alpha-blockers was not associated with hip/femur fracture in men with a diagnosis of benign prostatic hyperplasia (adjusted OR 1.0, 95% CI: 0.4-2.5), but was associated in men who used alpha-blockers for cardiovascular disease (adjusted OR 2.8, 95% CI: 1.4-5.4).


CONCLUSIONS
Current use of alpha-blockers was associated with an increased risk of hip/femur fracture and with the start of a new treatment episode. The effect seemed to be confined to patients who used alpha-blockers for cardiovascular disease. Caution with respect to first-dose effects related to the initiation of a new episode of alpha-blocker treatment is advised.
Souverein
P C
PC
Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands. p.c.souverein@pharm.uu.nl
Van Staa
T P
TP
Egberts
A C G
AC
De la Rosette
J J M C H
JJ
Cooper
C
C
Leufkens
H G M
HG
D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000188:drug therapy; D016022:Case-Control Studies; D005264:Femoral Fractures / Q000139:chemically induced* / Q000453:epidemiology; D006620:Hip Fractures / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011470:Prostatic Hyperplasia / Q000188:drug therapy; D018570:Risk Assessment / Q000379:methods; D006113:United Kingdom / Q000453:epidemiology
D000317:Adrenergic alpha-Antagonists