title: Laxative use and incident falls, fractures and change in bone mineral density in postmenopausal women: results from the Women's Health Initiative.
abstract: BACKGROUND
  Laxatives are among the most widely used over-the-counter medications in the United States but studies examining their potential hazardous side effects are sparse. Associations between laxative use and risk for fractures and change in bone mineral density [BMD] have not previously been investigated.
  
  
  METHODS
  This prospective analysis included 161,808 postmenopausal women (8907 users and 151,497 nonusers of laxatives) enrolled in the WHI Observational Study and Clinical Trials. Women were recruited from October 1, 1993, to December 31, 1998, at 40 clinical centers in the United States and were eligible if they were 50 to 79 years old and were postmenopausal at the time of enrollment. Medication inventories were obtained during in-person interviews at baseline and at the 3-year follow-up visit on everyone. Data on self-reported falls (≥2), fractures (hip and total fractures) were used. BMD was determined at baseline and year 3 at 3 of the 40 clinical centers of the WHI.
  
  
  RESULTS
  Age-adjusted rates of hip fractures and total fractures, but not for falls were similar between laxative users and non-users regardless of duration of laxative use. The multivariate-adjusted hazard ratios for any laxative use were 1.06 (95% confidence interval [CI], 1.03-1.10) for falls, 1.02 (95% CI, 0.85-1.22) for hip fractures and 1.01 (95% CI, 0.96-1.07) for total fractures. The BMD levels did not statistically differ between laxative users and nonusers at any skeletal site after 3-years intake.
  
  
  CONCLUSIONS
  These findings support a modest association between laxative use and increase in the risk of falls but not for fractures. Its use did not decrease bone mineral density levels in postmenopausal women. Maintaining physical functioning, and providing adequate treatment of comorbidities that predispose individuals for falls should be considered as first measures to avoid potential negative consequences associated with laxative use.
authors: Department of Internal Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Oberdürrbacher Strasse 6, Würzburg 97080, Germany. Haring_B@medizin.uni-wuerzburg.de
authors: Bernhard
authors: B
authors: Haring
authors: Mary
authors: M
authors: Pettinger
authors: Jennifer W
authors: JW
authors: Bea
authors: Jean
authors: J
authors: Wactawski-Wende
authors: Ryan M
authors: RM
authors: Carnahan
authors: Judith K
authors: JK
authors: Ockene
authors: Moritz
authors: M
authors: Wyler von Ballmoos
authors: Robert B
authors: RB
authors: Wallace
authors: Sylvia
authors: S
authors: Wassertheil-Smoller
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D015519:Bone Density / Q000187:drug effects / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000139:chemically induced / Q000453:epidemiology* / Q000378:metabolism; D006801:Humans; D015994:Incidence; D054368:Laxatives / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy / Q000453:epidemiology* / Q000378:metabolism; D011446:Prospective Studies; D016387:Women's Health
chemical_list: D054368:Laxatives
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