Thiazide diuretics and the risk for hip fracture
Thiazide diuretics and the risk for hip fracture
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DOI：
10.7326/0003-4819-139-6-200309160-00010
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发表时间：
2003-09-16
影响因子：
39.2
通讯作者：
Stricker, BHC
中科院分区：
文献类型：
--
作者：
Schoofs, MWCJ;van der Klift, M;Stricker, BHC
背景：由于大多数髋部骨折与骨质疏松症有关，治疗加速骨质流失可能是预防髋部骨折的重要策略。噻嗪类药物通过减少尿钙排泄与减少年龄相关性骨质流失有关。目的：探讨噻嗪类利尿剂使用剂量和持续时间与髋部骨折风险的关系，并研究停止使用的后果。设计：前瞻性人群队列研究。环境：鹿特丹书房。参与者：7891名55岁及以上的个体。测量方法：髋部骨折由全科医生报告，并由训练有素的研究助理进行验证。所有配发药物的详细信息每天都可以获得。接触噻嗪类药物被分为7个相互排斥的类别：从未使用、目前使用1至42天、目前使用43至365天、目前使用365天以上、1至60天停止使用、61至120天停止使用、120天以上停止使用。结果：髋部骨折281例。与不使用噻嗪类药物相比，目前使用噻嗪类药物超过365天与髋部骨折风险降低有统计学显著相关（危险比为0.46 [95% Cl， 0.21至0.96]）。没有明显的剂量依赖性。这种较低的风险在停止使用噻嗪后大约4个月消失。结论：噻嗪类利尿剂对髋部骨折有保护作用，但这种保护作用在停用后4个月内消失。
Background: Since most hip fractures are related to osteoporosis, treating accelerated bone loss can be an important strategy to prevent hip fractures. Thiazides have been associated with reduced age-related bone loss by decreasing urinary calcium excretion.Objective: To examine the association between dose and duration of thiazide diuretic use and the risk for hip fracture and to study the consequences of discontinuing use.Design: Prospective population-based cohort study.Setting: The Rotterdam Study.Participants: 7891 individuals 55 years of age and older.Measurements: Hip fractures were reported by the general practitioners and verified by trained research assistants. Details of all dispensed drugs were available on a day-to-day basis. Exposure to thiazides was divided into 7 mutually exclusive categories: never use, current use for 1 to 42 days, current use for 43 to 365 days, current use for more than 365 days, discontinuation of use since 1 to 60 days, discontinuation of use since 61 to 120 days, and discontinuation of use since more than 120 days.Results: 281 hip fractures occurred. Relative to nonuse, current use of thiazides for more than 365 days was statistically significantly associated with a lower risk for hip fracture (hazard ratio, 0.46 [95% Cl, 0.21 to 0.96]). There was no clear dose dependency. This lower risk disappeared approximately 4 months after thiazide use was discontinued.Conclusions: Thiazide diuretics protect against hip fracture, but this protective effect disappears within 4 months after use is discontinued.