Antihypertensive drugs demonstrate varying levels of hip fracture risk: A systematic review and meta-analysis

Langerhuizen, David W. G.; Verweij, Lukas P.E.; Wouden, Johannes C. van der; Kerkhoffs, Gino M. M. J.; Janssen, Stein J.

doi:10.1016/j.injury.2021.09.036

Cited by 6 publications

(3 citation statements)

References 55 publications

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“…In addition, the levels of individual indicators may abnormal under the history of malignant tumors [ 28 ]. And Treatment with antihypertensive [ 29 ], hypoglycemic [ 30 ], or lipid-lowering medication [ 31 ] might have had an effect on our study outcomes. However, the sensitivity analysis showed that removal of the above populations did not affect the final results, indicating that our findings are robust.…”

Section: Discussionmentioning

confidence: 99%

New-onset stroke on the risk of hip fracture: the Kailuan cohort study in China

Zhang

Guo

et al. 2023

BMC Public Health

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Purpose Stroke is a documented risk factor for hip fracture(HF). However, no data is currently available on this issue in mainland China, we therefore assessed the risk of hip fracture after new-onset stroke using a cohort study. Methods This study included 165,670 participants without a history of stroke at baseline from the Kailuan study. All participants were followed biennially until December 31, 2021. During follow-up, a total of 8,496 new-onset stroke cases were identified. For each case subject, four control subjects was randomly selected, matched for age (± 1 years) and sex. The final analysis comprised 42,455 pair-matched cases and controls. A multivariate Cox proportional hazard regression model was used to estimate the effect of new-onset stroke on the risk of hip fracture. Results During an average follow-up of 8.87 (3.94) years, a total of 231 hip fracture cases occurred, 78 cases in the stroke group and 153 cases in the control group, with incidence rates of 1.12 and 0.50 per 1000 person-years, respectively. The cumulative incidence of the stroke group was higher than that of the controls (P < 0.01). The adjusted hazard ratio (95% confidence interval) of hip fractures in the stroke group was 2.35 (1.77 to 3.12) (P < 0.001) to controls. After stratifying by gender, age, and body mass index, the higher risk was revealed in female (HR 3.10, 95 CI: 2.18 to 6.14, P < 0.001), age < 60 years old (HR 4.12, 95% CI: 2.18 to 7.78, P < 0.001), and non-obesity (BMI<28 kg/m2) (HR 1.74, 95% CI:1.31 to 2.31, P < 0.001) subgroup. Conclusions Stroke significantly increases the risk of hip fracture, strategy for protecting stroke patients from falls and hip fractures should be emphasized in poststroke long-term management, particularly the female, age < 60 years old, and non-obese patients.

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Section: Discussionmentioning

confidence: 99%

New-onset stroke on the risk of hip fracture: the Kailuan cohort study in China

Zhang

Guo

et al. 2023

BMC Public Health

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“…That study also noted that the choice of antihypertensive can influence fracture risk. A recent meta-analysis including 22 observational studies concluded the use of thiazide was associated with a lower fracture rate of the hip [ 31 ]. A meta-analysis that compared patients with diuresis with and without thiazide determined that thiazide reduced overall fracture risk by 14% and hip fracture risk by 18% [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Association of Thiazide Use in Patients with Hypertension with Overall Fracture Risk: A Population-Based Cohort Study

Chuang

Yang

Liao

et al. 2022

JCM

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Thiazide diuretics have long been widely used as antihypertensive agents. In addition to reducing blood pressure, thiazides also control calcium homeostasis and increase bone density. We hypothesized that the use of thiazides in patients with hypertension would reduce overall fracture risk. We used the Taiwan National Health Insurance Research Database to find patients with a hypertension diagnosis who accepted antihypertensive treatment from 2000 to 2017. The patients were further classified into thiazide users and nonthiazide users. Multivariable Cox regression analysis and Kaplan–Meier survival analysis were performed to estimate the adjusted hazard ratios (aHRs) and cumulative probability of fractures. After 1:1 propensity score matching by sex, age, urbanization level of place of residence, income, comorbidities, and medications, there were 18,483 paired thiazide users and non-users, respectively. The incidence densities of fractures (per 1000 person-months) were 1.82 (95% CI: 1.76–1.89) and 1.99 (95% CI: 1.92–2.06) in the thiazide and nonthiazide groups, respectively. The results indicated a lower hazard ratio for fractures in thiazide users (aHR = 0.93, 95% CI: 0.88–0.98). Kaplan–Meier survival analysis revealed a significantly lower cumulative incidence of fractures in the thiazide group (log-rank test; p = 0.0012). In conclusion, our results reveal that thiazide use can reduce fracture risk. When antihypertensive agents are being considered, thiazide may be a better choice if the patient is at heightened risk of fracture.

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“…The cohort study in the Osteoporotic Fracture in Men Study (MrOS) reported that using angiotensin receptor blockers (ARBs) for prolonged periods reduced the risk of non-vertebral fractures in the elderly compared to using angiotensin-converting enzyme inhibitors (ACEIs) or calcium channel blockers (CCBs) ( 4 ). A recent meta-analysis illustrated that thiazide diuretics, beta-blockers (BBs), and ARBs could reduce the risk of hip fracture ( 5 ). Recent studies regarding the risk of falls in older adults have also raised concerns about hip fracture resulted from antihypertensive drug use ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Association of antihypertensive drugs with fracture and bone mineral density: A comprehensive drug-target Mendelian randomization study

et al. 2023

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BackgroundObservational studies have investigated the associations between antihypertensive drugs and fracture risk as well as bone mineral density (BMD), but yielding controversial results.MethodsIn this study, a comprehensive drug-target Mendelian randomization (MR) analysis was conducted to systematically examine the associations between genetic proxies for eight common antihypertensive drugs and three bone health-related traits (fracture, total body BMD [TB-BMD], and estimated heel BMD [eBMD]). The main analysis used the inverse-variance weighted (IVW) method to estimate the causal effect. Multiple MR methods were also employed to test the robustness of the results.ResultsThe genetic proxies for angiotensin receptor blockers (ARBs) were associated with a reduced risk of fracture (odds ratio [OR] = 0.67, 95% confidence interval [CI]: 0.54 to 0.84; P = 4.42 × 10-4; P-adjusted = 0.004), higher TB-BMD (β = 0.36, 95% CI: 0.11 to 0.61; P = 0.005; P-adjusted = 0.022), and higher eBMD (β = 0.30, 95% CI: 0.21 to 0.38; P = 3.59 × 10-12; P-adjusted = 6.55 × 10-11). Meanwhile, genetic proxies for calcium channel blockers (CCBs) were associated with an increased risk of fracture (OR = 1.07, 95% CI: 1.03 to 1.12; P = 0.002; P-adjusted = 0.013). Genetic proxies for potassium sparing diuretics (PSDs) showed negative associations with TB-BMD (β = -0.61, 95% CI: -0.88 to -0.33; P = 1.55 × 10-5; P-adjusted = 1.86 × 10-4). Genetic proxies for thiazide diuretics had positive associations with eBMD (β = 0.11, 95% CI: 0.03 to 0.18; P = 0.006; P-adjusted = 0.022). No significant heterogeneity or pleiotropy was identified. The results were consistent across different MR methods.ConclusionsThese findings suggest that genetic proxies for ARBs and thiazide diuretics may have a protective effect on bone health, while genetic proxies for CCBs and PSDs may have a negative effect.

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Antihypertensive drugs demonstrate varying levels of hip fracture risk: A systematic review and meta-analysis

Cited by 6 publications

References 55 publications

New-onset stroke on the risk of hip fracture: the Kailuan cohort study in China

New-onset stroke on the risk of hip fracture: the Kailuan cohort study in China

Association of Thiazide Use in Patients with Hypertension with Overall Fracture Risk: A Population-Based Cohort Study

Association of antihypertensive drugs with fracture and bone mineral density: A comprehensive drug-target Mendelian randomization study

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