title: Fracture risk after thiazide-associated hyponatraemia.
abstract: OBJECTIVE
  Although thiazide-type diuretics can promote a positive calcium balance, thiazide can be associated with hyponatraemia, which is recently linked with heightened fracture risk. We examine the chance of developing fracture in patients with and without hyponatraemia after taking thiazide diuretics.
  
  
  METHODS
  In this single-centre retrospective study, we followed up a previously published cohort of patients with (n= 223) and without (n= 216) thiazide-induced hyponatraemia.
  
  
  RESULTS
  A total of 61 osteoporotic fractures was recorded during a mean follow-up period of 82 months. Using univariate regression analysis, the hazard ratio of thiazide-induced hyponatraemia was 1.78 (95% confidence interval (CI), 1.05-3.03; P= 0.033). Cox proportional hazards regression analysis, however, showed that age, body mass index and diabetes mellitus were the only independent predictors of osteoporotic fractures. No association of a history of thiazide-induced hyponatraemia and risk of fracture was evident in the final model.
  
  
  CONCLUSIONS
  Since a history of thiazide-induced hyponatraemia is associated with osteoporotic fracture in univariate but not multivariate analyses, an alternative explanation is that confounding factors of older age and low body mass index accounted for the apparently increased risk of osteoporotic fracture in patients with thiazide-induced hyponatraemia.
authors.affiliation: Division of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China. chow_kai_ming@alumni.cuhk.net
authors.forename: K M
authors.initials: KM
authors.lastname: Chow
authors.forename: C C
authors.initials: CC
authors.lastname: Szeto
authors.forename: B C-H
authors.initials: BC
authors.lastname: Kwan
authors.forename: T K-W
authors.initials: TK
authors.lastname: Ma
authors.forename: C B
authors.initials: CB
authors.lastname: Leung
authors.forename: P K-T
authors.initials: PK
authors.lastname: Li
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000097:blood / Q000453:epidemiology; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000097:blood / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D049993:Sodium Chloride Symporter Inhibitors / Q000009:adverse effects* / Q000097:blood
chemical_list: D049993:Sodium Chloride Symporter Inhibitors