title: Thiazide use is associated with reduced risk for incident lower extremity fractures in men with spinal cord injury.
abstract: OBJECTIVE
  To determine the association between thiazide use and lower extremity fractures in patients who are men with a spinal cord injury (SCI).
  
  
  METHODS
  Cohort study from fiscal years 2002 to 2007.
  
  
  METHODS
  Medical centers.
  
  
  METHODS
  Men (N=6969) with an SCI from the Veterans Affairs (VA) Spinal Cord Dysfunction (SCD) Registry, including 1433 users of thiazides and 5536 nonusers of thiazides.
  
  
  METHODS
  Thiazide use versus nonuse.
  
  
  METHODS
  Incident lower extremity fractures.
  
  
  RESULTS
  Among the men, 21% in the VA SCD Registry (fiscal years 2002-2007) included in these analyses used thiazide diuretics. There were 832 incident lower extremity fractures over the time period of this study: 110 fractures (7.7%) in 1433 thiazide users and 722 fractures (13%) in 5536 nonusers of thiazides. In unadjusted and adjusted models alike, thiazide use was associated with at least a one-quarter risk reduction in lower extremity fracture at any given point in time (unadjusted: hazard ratio (HR)=.75; 95% confidence interval (CI), .59-.94; adjusted: HR=.74; 95% CI, .58-.95).
  
  
  CONCLUSIONS
  Thiazide use is common in men with SCI and is associated with a decreased likelihood for lower extremity fractures.
authors.affiliation: Charlie Norwood Veterans Affairs Medical Center, Augusta, GA; Department of Medicine, Georgia Regents University, Augusta, GA. Electronic address: lcarbone@gru.edu.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Carbone
authors.affiliation: Edward J. Hines, Jr Veterans Affairs Hospital, Hines, IL.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Chin
authors.affiliation: Edward J. Hines, Jr Veterans Affairs Hospital, Hines, IL; University of Illinois at Chicago, Chicago, IL.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Lee
authors.affiliation: Spinal Cord Injury Service, Veterans Affairs Puget Sound, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Burns
authors.affiliation: Spinal Cord Injury Service, Veterans Affairs Puget Sound, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
authors.forename: Jelena N
authors.initials: JN
authors.lastname: Svircev
authors.affiliation: Durham Veterans Affairs Medical Center, Durham, NC.
authors.forename: Helen M
authors.initials: HM
authors.lastname: Hoenig
authors.affiliation: Edward J. Hines, Jr Veterans Affairs Hospital, Hines, IL; University of Illinois at Chicago, Chicago, IL.
authors.forename: Lauren
authors.initials: L
authors.lastname: Bailey
authors.affiliation: Edward J. Hines, Jr Veterans Affairs Hospital, Hines, IL; Stritch School of Medicine, Loyola University, Maywood, IL.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Weaver
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology* / Q000517:prevention & control; D006787:Hospitals, Veterans; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D035002:Lower Extremity / Q000293:injuries; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use*; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000534:rehabilitation
chemical_list: D049993:Sodium Chloride Symporter Inhibitors
keywords: Fractures, bone; Men; Rehabilitation; Spinal cord injuries; Thiazides