title: Number of daily antihypertensive drugs and the risk of osteoporotic fractures in older hypertensive adults: National health insurance service - Senior cohort.
abstract: Antihypertensive medication represents one of the most common prescriptions for senior individuals. Numerous studies have assessed the influence of antihypertensive treatment on the risk for osteoporotic fracture, yet much controversy remains. We analyzed the relationship between the incidence of osteoporotic fracture and the average number of daily antihypertensive drugs (NDAD) included in the prescription of elderly hypertensive patients.
  
  
  
  The study population was derived from the National Health Insurance Service-Senior Cohort (2002-2013), and consisted of elderly patients (≥60 years) diagnosed with hypertension in 2009, who did not have osteoporotic fractures in 2008, and underwent at least one national health check-up between 2009 and 2013, and had complete records after 2010. The outcome measured was the incidence of osteoporotic fractures between 2010 and 2013. The study population was stratified into the three groups (low, moderate, and high), in terms of NDAD.
  
  
  
  A total of 137,304 hypertensive patients were included. A multivariate model corrected by age, gender, body mass index, systolic blood pressure, underlying disease, smoking status, and use of medicines showed that the groups with moderate and high NDAD exhibited, respectively, 12% and 16% lower risk of osteoporotic fracture compared to that in the group with low NDAD. In terms of the risk of osteoporotic fracture associated with the number of daily thiazide diuretics (NDTD), the adjusted odds ratios (aOR; 95%CI) were 0.89 (0.84-0.94) and 0.93 (0.84-1.02) in the groups with moderate and high NDTD, respectively compared to low NDTD as reference. As to NDADnotTD, the aOR (95%CI) were 0.90 (95%CI, 0.86-0.94) and 0.89 (95%CI, 0.84-0.95) in the groups with moderate and high NDADnotTD, respectively compared to low NDADnotTD as reference.
  
  
  
  In elderly hypertensive patients, the incidence of osteoporotic fracture decreased as the NDAD increased. The incidence rate of osteoporotic fracture also decreased with the increase in the number of daily non-thiazide antihypertensive drugs.
authors.affiliation: Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Department of Medicine, Kyung Hee University Graduate School, Seoul, Republic of Korea.
authors.forename: Sunyoung
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Statistics, Dongguk University, Seoul, Republic of Korea.
authors.forename: Sung Eun
authors.initials: SE
authors.lastname: Choi
authors.affiliation: Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
authors.forename: Byung Sung
authors.initials: BS
authors.lastname: Kim
authors.affiliation: Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
authors.forename: Hyun Rim
authors.initials: HR
authors.lastname: Choi
authors.affiliation: Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
authors.forename: Deri
authors.initials: D
authors.lastname: Hwang
authors.affiliation: Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea. Electronic address: chunwon62@naver.com.
authors.forename: Chang Won
authors.initials: CW
authors.lastname: Won
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D015994:Incidence; D008297:Male; D009313:National Health Programs; D016017:Odds Ratio; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D012306:Risk; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D049993:Sodium Chloride Symporter Inhibitors
keywords: Antihypertensive drugs; Elderly; Hypertension; Osteoporosis; Osteoporotic fracture