title: The association of α-blockers and 5-α reductase inhibitors in benign prostatic hyperplasia with fractures.
abstract: BACKGROUND
  Alpha-blockers and 5-alpha reductase inhibitors are common drugs used to treat benign prostatic hyperplasia (BPH), a prevalent problem in older men associated with significant morbidity and cost. Data regarding how these medications affect skeletal health and fracture risk remain scarce.
  
  
  METHODS
  Studies were identified by searching PubMed, EMBASE, the Cochrane library and Thomson Reuters Web of Knowledge. Studies involving BPH patients that reported odds ratio (OR) estimates with 95% confidence intervals (CIs) for the association between fractures and exposure to 5-alpha reductase inhibitors or alpha-blockers were included. Pooled ORs were calculated using the random-effects model.
  
  
  RESULTS
  Three studies addressed fracture risk in patients exposed to 5-alpha reductase inhibitors (21,366 fracture cases). Four studies addressed fracture risk in patients exposed to alpha-blockers (22,051 fracture cases). The pooled OR for fractures with 5-alpha reductase inhibitor use was 0.9 (95% CI = 0.7-1.1). For hip/femur fractures with 5-alpha reductase inhibitor use, the pooled OR was 0.8 (95% CI = 0.7-1.0). The pooled OR for fractures with alpha-blockers was 1.1 (95% CI = 0.9-1.3). There was significant statistical heterogeneity among studies for alpha-blockers.
  
  
  CONCLUSIONS
  In patients with BPH, exposure to 5-alpha reductase inhibitors was not associated with change in fracture risk. The 5-alpha reductase inhibitors may have a small protective effect against hip/femur fractures although this was not statistically significant. Although alpha-blockers were not associated with change in fracture risk, caution is required when interpreting the results as significant heterogeneity was present.
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
authors.forename: Sian Yik
authors.initials: SY
authors.lastname: Lim
authors.forename: Pavis
authors.initials: P
authors.lastname: Laengvejkal
authors.forename: Ragesh
authors.initials: R
authors.lastname: Panikkath
authors.forename: Kenneth
authors.initials: K
authors.lastname: Nugent
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D018849:Controlled Clinical Trials as Topic / Q000379:methods; D050723:Fractures, Bone / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D011470:Prostatic Hyperplasia / Q000188:drug therapy* / Q000201:enzymology / Q000453:epidemiology*
chemical_list: D058891:5-alpha Reductase Inhibitors; D000317:Adrenergic alpha-Antagonists