title: Thiazide diuretics and the risk of osteoporotic fractures in hypertensive patients. Results from the Swedish Primary Care Cardiovascular Database.
abstract: The objective is to investigate if treatment with thiazides reduces the risk of osteoporotic fractures in hypertensive patients in primary healthcare. Further we aimed to examine the impact of duration of thiazide use, the consequences of discontinuation of treatment, and the possible difference in effect between men and women.
  
  
  
  This retrospective cohort study includes 57 822 individuals, 45 years and older, diagnosed with hypertension during 2001-2008 in the Swedish Primary Care Cardiovascular Database. Patients were followed from 1 January 2006 (or the date of their first diagnosis of hypertension if that date came later), until they had an incident osteoporotic fracture, died, or reached the end of the study at 31 December 2012. Patients exposed to thiazides were compared with patients never exposed to thiazides.
  
  
  
  Current use of thiazides was associated with significantly reduced risk of osteoporotic fractures [hazards ratio 0.89; 95% confidence interval (CI) 0.81-0.98], and increased with longer treatment periods (hazards ratio 0.87; 95% CI 0.78-0.97 after 2 years). However, discontinuation of thiazides increased the risk of osteoporotic fractures (hazards ratio 1.18; 95% CI 1.04-1.33), but attenuated with longer duration past treatment period. When analyzing men and women separately, similar results were seen, although only significant in men.
  
  
  
  This large observational study confirms that thiazide therapy in hypertensive patients is associated with a reduced risk of osteoporotic fractures. The protective effect increased with longer treatment periods. However, discontinuation of treatment increased the risk of fractures, which emphasizes the importance of continuous treatment.
authors.affiliation: aDepartment of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg bDivision of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm cNärhälsan R&D Centre Primary Care, Skaraborg, Skövde dDepartment of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet, Stockholm eDepartment of Internal Medicine and Geriatrics, Centre for Bone Research fSection of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Tove
authors.initials: T
authors.lastname: Bokrantz
authors.forename: Charlotta
authors.initials: C
authors.lastname: Ljungman
authors.forename: Thomas
authors.initials: T
authors.lastname: Kahan
authors.forename: Kristina B
authors.initials: KB
authors.lastname: Boström
authors.forename: Jan
authors.initials: J
authors.lastname: Hasselström
authors.forename: Per
authors.initials: P
authors.lastname: Hjerpe
authors.forename: Dan
authors.initials: D
authors.lastname: Mellström
authors.forename: Linus
authors.initials: L
authors.lastname: Schiöler
authors.forename: Karin
authors.initials: K
authors.lastname: Manhem
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004232:Diuretics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D016016:Proportional Hazards Models; D065840:Protective Factors; D012189:Retrospective Studies; D012737:Sex Factors; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use*; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
chemical_list: D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors