title: Danish register-based study on the association between specific cardiovascular drugs and fragility fractures.
abstract: OBJECTIVE
  To determine whether drugs used in treatment of cardiovascular diseases (CVD-drugs), including hypertension, increase the risk of fragility fractures in individuals above the age of 65 years.
  
  
  METHODS
  Retrospective nationwide cohort study.
  
  
  METHODS
  Danish nationwide national registers.
  
  
  METHODS
  All individuals in Denmark ≥ 65 years who used specified CVD-drugs in the study period between 1999 and 2012.
  
  
  METHODS
  Time-dependent exposure to CVD-drugs (nitrates, digoxin, thiazides, furosemide, ACE inhibitors, angiotensin receptor antagonists, β-blockers, calcium antagonists and statins) was determined by prescription claims from pharmacies. The association between use of specific CVD-drugs and fragility fractures was assessed using multivariable Poisson regression models, and adjusted incidence rate ratios (IRRs) were calculated.
  
  
  RESULTS
  Overall, 1,586,554 persons were included, of these 16.1% experienced a fall-related fracture. The multivariable Poisson regression analysis showed positive associations between fracture and treatment with furosemide, thiazide and digoxin. IRRs during the first 14 days of treatment were for furosemide IRR 1.74 (95% CI 1.61 to 1.89) and for thiazides IRR 1.41 (1.28 to 1.55); IRR during the first 30 days of treatment with digoxin was 1.18 (1.02 to 1.37).
  
  
  CONCLUSIONS
  Use of furosemide, thiazides and digoxin was associated with elevated rates of fragility fractures among elderly individuals. This may warrant consideration when considering diuretic treatment of hypertension in elderly individuals.
authors.affiliation: Department of Geriatric Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark.
authors.forename: Maia
authors.initials: M
authors.lastname: Torstensson
authors.affiliation: Department of Internal Medicine, Slagelse Hospital, Slagelse, Denmark.
authors.forename: Annette Højmann
authors.initials: AH
authors.lastname: Hansen
authors.affiliation: Department of Geriatric Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark.
authors.forename: Katja
authors.initials: K
authors.lastname: Leth-Møller
authors.affiliation: Department of Geriatric Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark.
authors.forename: Terese Sara Høj
authors.initials: TS
authors.lastname: Jørgensen
authors.affiliation: Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Marie
authors.initials: M
authors.lastname: Sahlberg
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Andersson
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Karl Emil
authors.initials: KE
authors.lastname: Kristensen
authors.affiliation: Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Ryg
authors.affiliation: Department of Cardiology, Laboratory of Molecular Cardiology, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Weeke
authors.affiliation: Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Gislason
authors.affiliation: Department of Geriatric Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark.
authors.forename: Ellen
authors.initials: E
authors.lastname: Holm
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000009:adverse effects* / Q000145:classification; D003718:Denmark / Q000453:epidemiology; D004077:Digoxin / Q000009:adverse effects; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D005665:Furosemide / Q000009:adverse effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D015999:Multivariate Analysis; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D049971:Thiazides / Q000009:adverse effects
chemical_list: D002317:Cardiovascular Agents; D049971:Thiazides; D004077:Digoxin; D005665:Furosemide
keywords: accidental falls; cardiovaslular drugs; fragility fractures