title: Long-term Effects of Antihypertensive Drug Use and New-onset Osteoporotic Fracture in Elderly Patients: A Population-based Longitudinal Cohort Study.
abstract: BACKGROUND
  Antihypertensive drugs have been linked to new-onset osteoporotic fracture (NOF), and different classes of antihypertensive drugs may alter the risk for the development of NOF; however, the classic effect of different antihypertensive drugs on the development of NOF in the elderly has not been well studied during long-term follow-up.
  
  
  METHODS
  In this study, we investigated the association between different classic antihypertensives and the development of NOF in the elderly. This was a longitudinal cohort study performed using data from claim forms submitted to the Taiwan Bureau of National Health Insurance in Central Taiwan, China including case patients with NOF aged 65-80 years from January 2002 to December 2012 and non-NOF controls. Prescriptions for antihypertensives before the index date were retrieved from a prescription database. We estimated the hazard ratios (HR s) of NOF associated with antihypertensive use. Non-NOF controls served as the reference group.
  
  
  RESULTS
  A total of 128 patients with NOF were identified from among 1144 patients with hypertension during the study period. The risk of NOF after adjusting age, sex, comorbidities, and concurrent medications was higher among the users of angiotensin-converting enzyme (ACE) inhibitors (HR, 1.64; 95% confidence interval [CI], 1.01-2.66) than among nonusers. Patients who took calcium channel blockers (CCBs) (HR, 0.70; 95% CI, 0.49-0.99) were at a lower risk of developing NOF than nonusers. Loop diuretics, thiazide diuretics, angiotensin receptor blocker, beta-blocker, and alpha-blocker were not associated with the risk of NOF.
  
  
  CONCLUSIONS
  Elderly with hypertension who take CCBs are at a lower risk of NOF and that the use of ACE inhibitors was associated with a significantly increased risk of developing NOF during the 11-year follow-up.
authors.affiliation: Institute of Pharmacy, China Medical University, Taichung, Taiwan 40402; Department of Pharmacy, China Medical University Beigang Hospital, Yunlin County, Taiwan 65152, China.
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Chen
authors.affiliation: Department of Endocrinology and Metabolism, Shangluo Central Hospital, Shangluo, Shaanxi 726000, China.
authors.forename: Kai-Yan
authors.initials: KY
authors.lastname: Ma
authors.affiliation: Institute of Pharmacy, China Medical University, Taichung, Taiwan 40402, China.
authors.forename: Pei-Ling
authors.initials: PL
authors.lastname: Hsieh
authors.affiliation: Department of Family Medicine and Geriatrics, School of Public Health, National Defense Medical Center, Taichung Veteran General Hospital, Taichung, Taiwan 40705, China.
authors.forename: Yi-Sheng
authors.initials: YS
authors.lastname: Liou
authors.affiliation: Division of Internal Cardiology, Chung Shan Medical University Hospital, Chung Shan Medical University, Taichung, Taiwan 40201; Department of Basic Science, Central Taiwan University of Science and Technology, Taichung, Taiwan 40601, China.
authors.forename: Gwo-Ping
authors.initials: GP
authors.lastname: Jong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008137:Longitudinal Studies; D008297:Male; D058866:Osteoporotic Fractures / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers