Comparative study of modified release alpha-blocker exposure in elderly patients with fractures.
OBJECTIVE
Standard formulation alpha-blocker use has been associated with an increased risk of hypotension-related adverse events, particularly with cardiovascular indications and on treatment initiation. We investigated the association between those fractures that are commonly due to falls and modified-release doxasozin exposure.


METHODS
A case-control study using UK primary care records (the THIN database) showed that 6540 cases aged 50 years or older had a record of first fracture of the hip/femur, humerus or wrist after May 2001; 26 495 controls had no fracture and were matched on practice, year of birth and sex. Exclusions for the primary analysis were previous benign prostatic hypertrophy (BPH), lower urinary tract symptoms (LUTS) or prostate cancer, major trauma at the time of the case's fracture, or a history of falls. Conditional logistic regression estimated the association between modified-release doxasozin treatment and the occurrence of fractures.


RESULTS
No increased risk of fractures was associated with current use of modified-release doxasozin, adjusted odds ratios (ORs) 0.90 (95%CI 0.68, 1.19); previous use, adjusted OR 0.92 (95%CI 0.73, 1.16) or the start of a treatment episode (</=28 days), crude OR 0.57 (0.17, 1.92). Including those with a history of BPH, LUTS and prostatic carcinoma had little effect, adjusted OR for current use was 0.95 (95%CI 0.74, 1.21). No significant increased risk of fractures was associated with the start of standard preparation alpha-blockers, crude OR 1.42 (95%CI 0.65, 3.07).


CONCLUSIONS
We found no association between modified-release doxasozin use and fractured hip/femur, humerus or wrist in those without a recent history of falls, or trauma.
Hall
Gillian C
GC
Grimsdyke House, London, UK. gillian_hall@gchall.demon.co.uk
McMahon
Alex D
AD
D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003692:Delayed-Action Preparations; D017292:Doxazosin / Q000009:adverse effects*; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology / Q000209:etiology; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D006810:Humeral Fractures / Q000453:epidemiology / Q000209:etiology; D006973:Hypertension / Q000188:drug therapy*; D007022:Hypotension / Q000139:chemically induced* / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018570:Risk Assessment; D006113:United Kingdom; D014954:Wrist Injuries / Q000453:epidemiology / Q000209:etiology
D000317:Adrenergic alpha-Antagonists; D003692:Delayed-Action Preparations; D017292:Doxazosin