Loop Diuretic Use and Fracture in Postmenopausal Women Findings From the Women's Health Initiative
Loop Diuretic Use and Fracture in Postmenopausal Women Findings From the Women's Health Initiative
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DOI：
10.1001/archinternmed.2008.526
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发表时间：
2009-01-26
影响因子：
--
通讯作者：
LaCroix, Andrea Z.
中科院分区：
文献类型：
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作者：
Carbone, Laura D.;Johnson, Karen C.;LaCroix, Andrea Z.
背景资料：髓袢利尿剂与绝经后妇女骨密度（BMD）、福尔斯和骨折的关系尚未建立。方法：我们研究了髓袢利尿剂是否与参加妇女健康倡议的妇女的BMD、福尔斯和骨折的变化相关。我们纳入了133855名妇女（3411名使用袢利尿剂的妇女和130444名未使用袢利尿剂的妇女），她们从1993年10月29日至1998年12月31日参加了WHI，并确定了平均7.7年的福尔斯和骨折事件。在基线和第3年进行BMD测量的女性结果：在调整协变量后，没有发现使用袢利尿剂与总的（风险比[HR]，1.09; 95%置信区间[CI]，1.00-1.19），髋关节（HR，1.21; 95% CI，0.91-1.60）、临床椎体骨折（HR，1.17; 95% CI，0.92-1.48）和福尔斯（1.02; 0.96-1.08）。使用髓袢利尿剂超过3年的其他临床骨折（1.16; 1.01-133）和全骨折（1.16; 1.03-1.31）的风险增加。BMD的变化与髓袢利尿剂的使用无关。结论：调整混杂变量后，未发现有史以来使用髓袢利尿剂与BMD、福尔斯和骨折变化之间存在显著相关性。健康状况不佳的妇女使用袢利尿剂，她们已经有骨折的危险。然而，长期使用袢利尿剂与绝经后妇女骨折风险升高相关。
Background: The relationship of loop diuretics to bone mineral density (BMD), falls, and fractures in postmenopausal women has not been established.Methods: We examined whether loop diuretics are associated with changes in BMD, falls, and fractures in women enrolled in the Women's Health Initiative. We included the 133 855 women (3411 users and 130 444 nonusers of loop diuretics) who were enrolled in the WHI from October 29, 1993 to December 31, 1998 and determined incident falls and fractures for a mean of 7.7 years. Women who had BMD measurements at baseline and at year 3 ( 300 users and 9124 nonusers of loop diuretics) were also examined.Results: After adjustment for covariates, no significant association was found between ever use of loop diuretics and total (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.00-1.19), hip (HR, 1.21; 95% CI, 0.91-1.60), and clinical vertebral fractures (HR, 1.17; 95% CI, 0.92-1.48) and falls (1.02; 0.96-1.08). An increased risk was found for other clinical fractures (1.16; 1.01-133) and total fractures (1.16; 1.03-1.31) with more than 3 years' use of loop diuretics. The BMD changes were not associated with loop diuretic use.Conclusions: After adjustment for confounding variables, no significant association was found between ever use of loop diuretics and changes in BMD, falls, and fractures. Loop diuretics were used by women in poor health who were already at risk for fractures. However, prolonged use of loop diuretics was associated with higher fracture risk in postmenopausal women.