Thiazide diuretic usage and risk of fracture: a meta-analysis of cohort studies

Xiao, Xiangxue; Xu, Yingke; Wu, Qing

doi:10.1007/s00198-018-4486-9

Cited by 30 publications

(25 citation statements)

References 38 publications

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“…Thus, it is important to focus on these medications when performing medication reviews in order to reduce the risk of medication related falls. Nevertheless, thiazides may also have a beneficial effect on bone strength by increasing renal calcium reabsorption [22]. The use of medications with an established bone-demineralizing effect, such as oral corticosteroids, aromatase inhibitors and enzymeinducing anti-epileptics, was infrequent in our population, suggesting a limited contribution to falls by these medications among hip fracture patients.…”

Section: (37)mentioning

confidence: 85%

Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study

et al. 2020

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Background: Hip fractures constitute a major health problem in elderly people and are often fall-related. Several factors can contribute to a fall episode leading to hip fracture, including fall-risk-increasing drugs (FRIDs), which are often used by elderly people. We aimed to investigate the prevalence of medication-related falls and to assess the role of FRIDs and potentially inappropriate medications (PIMs) in a population of elderly patients hospitalized for a hip fracture. Methods: We reviewed the patient records of 200 consecutive patients, aged ≥65 years, who were admitted for a hip fracture and evaluated whether medications were likely to have contributed to the fall episode. PIMs were identified using the Screening Tool of Older Persons' Prescriptions version 2 (STOPP) and by evaluating indications, contra-indications and interactions of the prescribed medications for each patient. Results: FRIDs were used by 175 patients (87.5%). Medications were considered a likely contributor to the fall in 82 patients (41%). These were most often psychotropic medications alone or in combination with antihypertensives and/or diuretics. The 82 patients with suspected medication-related falls used more medications, FRIDs and PIMs than the rest of the patients, and in 74 (90%) of the 82 patients, at least one medication considered to be a contributor to the fall was also a PIM. Conclusions: The prevalence of suspected medication-related falls was 41%. It seems likely that a medication review could have reduced, though not eliminated, the risk of falling in this group of patients.

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Section: (37)mentioning

confidence: 85%

Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study

et al. 2020

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“…Notable, some medications demonstrate opposite effects on bone metabolism and risk of falling. For instance, thiazide diuretics, beta-blockers, calcium-channel blockers and ACE inhibitors may contribute toward orthostatic hypotension, syncope and falls, but exert beneficial effect on mineral-bone metabolism and, paradoxically, may reduce fracture risk [ 547 , 552 , 589 , 590 , 591 , 592 , 593 , 594 , 595 , 596 , 597 , 598 ]. Some agents have shown divergent effects on bone and skeletal muscles.…”

Section: Hpi-associated Chronic Extra-gastroduodenal Diseases Medmentioning

confidence: 99%

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

Fisher

Smith

2020

JCM

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Osteoporosis (OP) and osteoporotic fractures (OFs) are common multifactorial and heterogenic disorders of increasing incidence. Helicobacter pylori (H.p.) colonizes the stomach approximately in half of the world’s population, causes gastroduodenal diseases and is prevalent in numerous extra-digestive diseases known to be associated with OP/OF. The studies regarding relationship between H.p. infection (HPI) and OP/OFs are inconsistent. The current review summarizes the relevant literature on the potential role of HPI in OP, falls and OFs and highlights the reasons for controversies in the publications. In the first section, after a brief overview of HPI biological features, we analyze the studies evaluating the association of HPI and bone status. The second part includes data on the prevalence of OP/OFs in HPI-induced gastroduodenal diseases (peptic ulcer, chronic/atrophic gastritis and cancer) and the effects of acid-suppressive drugs. In the next section, we discuss the possible contribution of HPI-associated extra-digestive diseases and medications to OP/OF, focusing on conditions affecting both bone homeostasis and predisposing to falls. In the last section, we describe clinical implications of accumulated data on HPI as a co-factor of OP/OF and present a feasible five-step algorithm for OP/OF risk assessment and management in regard to HPI, emphasizing the importance of an integrative (but differentiated) holistic approach. Increased awareness about the consequences of HPI linked to OP/OF can aid early detection and management. Further research on the HPI–OP/OF relationship is needed to close current knowledge gaps and improve clinical management of both OP/OF and HPI-related disorders.

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“…Steroid and bisphosphonate use was slightly more common and thiazide use was less common in residents with a femoral shaft fracture compared with other LE fracture types. Thiazide diuretics have been associated with a decreased risk of LE fracture in immobile men with spinal cord injury and a decreased risk of hip fracture in community dwellers . Given the modest difference we found in medication use among the LE fracture types, it is unclear whether medications influence risk of nonhip LE fractures in NH residents.…”

Section: Discussionmentioning

confidence: 75%

Incidence of Lower‐Extremity Fractures in US Nursing Homes

Sine

Lee

Zullo

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Limited studies suggest lower‐extremity (LE) fractures are morbid events for nursing home (NH) residents. Our objective was to conduct a nationwide study comparing the incidence and resident characteristics associated with hip (proximal femur) vs nonhip LE (femoral shaft and tibia‐fibula) fractures in the NH. DESIGN Retrospective cohort study. SETTING US NHs. PARTICIPANTS We included all long‐stay residents, aged 65 years or older, enrolled in Medicare from January 1, 2008, to December 31, 2009 (N = 1 257 279). Residents were followed from long‐stay qualification until the first event of LE fracture, death, or end of follow‐up (2 years). MEASUREMENTS Fractures were classified using Medicare diagnostic and procedural codes. Function, cognition, and medical status were obtained from the Minimum Data Set prior to long‐stay qualification. Incidence rates (IRs) were calculated as the total number of fractures divided by person‐years. RESULTS During 42 800 person‐years of follow‐up, 52 177 residents had an LE fracture (43 695 hip, 6001 femoral shaft, 2481 tibia‐fibula). The unadjusted IRs of LE fractures were 1.32/1000 person‐years (95% confidence interval [CI] = 1.27‐1.38) for tibia‐fibula, 3.20/1000 person‐years (95% CI = 3.12‐3.29) for femoral shaft, and 23.32/1000 person‐years (95% CI = 23.11‐23.54) for hip. As compared with hip fracture residents, non‐hip LE fracture residents were more likely to be immobile (58.1% vs 18.4%), to be dependent in all activities of daily living (31.6% vs 10.8%), to be transferred mechanically (20.5% vs 4.4%), to be overweight (mean body mass index = 26.6 vs 24.0 kg/m2), and to have diabetes (34.8% vs 25.7%). CONCLUSIONS Our findings that non‐hip LE fractures often occur in severely functionally impaired residents suggest these fractures may have a different mechanism of injury than hip fractures. The resident differences in our study highlight the need for distinct prevention strategies for hip and non‐hip LE fractures.

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Thiazide diuretic usage and risk of fracture: a meta-analysis of cohort studies

Abstract: Our findings indicate that thiazide diuretic use may convey a decreased risk of fracture and as such, the protective effect of this class of medicine should be considered when prescribing thiazide diuretics in clinical practice.

Cited by 30 publications

References 38 publications

Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study

Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

Incidence of Lower‐Extremity Fractures in US Nursing Homes

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