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January 16, 1991, Vol 265, No. 3 >
ARTICLE | January 16, 1991

Thiazide Diuretics and the Risk of Hip Fracture: Title and subTitle BreakResults From the Framingham Study FREE

David T. Felson, MD, MPH; Dorith Sloutskis, MPH; Jennifer J. Anderson, PhD; John M. Anthony; Douglas P. Kiel, MD, MPH
[+] Author Affiliations

Reprint requests to Arthritis Center, A-203, Boston University School of Medicine, 80 E Concord St, Boston, MA 02118 (Dr Felson).


JAMA. 1991;265(3):370-373. doi:10.1001/jama.1991.03460030076032
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References

Thiazide diuretics may preserve bone mass and prevent elderly women's osteopenic fractures, but studies have not distinguished between thiazide preparations or examined former users. We performed a case-control study looking at thiazide use and subsequent hip fracture in postmenopausal female members of the Framingham Study cohort. Cases who had experienced a first hip fracture (n = 176) were compared with age-matched controls (n = 672). Results showed a modest protective effect of any recent thiazide use (not significant). However, recent pure thiazide users experienced significant protection against fracture (adjusted odds ratio, 0.31; 95% confidence interval, 0.11 to 0.88), whereas recent users of combination drugs containing thiazides experienced no protection (adjusted odds ratio, 1.16; 95% confidence interval, 0.44 to 3.05). Combination drugs generally contained only 25 mg of hydrochlorothiazide, suggesting that the small amount of thiazide was insufficient to preserve bone mass. Former thiazide users were not protected against fracture. In sum, recent pure thiazide use in women protects against hip fracture.

(JAMA. 1991;265:370-373)

REFERENCES

1 +
Ljunghall S, Backman U, Danielson BG, Fellstrom B, Johnsson G, Wikstrom B.  Calcium and magnesium metabolism during long-term treatment with thiazides . Scand J Urol Nephrol. 1981;;15:257-262.
2 +
Wasnich RD, Benfante RJ, Yano K, Heilburn L, Vogel JM.  Thiazide effect on the mineral content of bone . N Eng J Med. 1983;;309:344-346.
3 +
Transbol I, Christensen MS, Jensen GF, Christiansen C, McNair P.  Thiazide for postponement of postmenopausal bone loss . Metabolism . 1982;;31: 383-386.
4 +
LaCroix AZ, Wienpahl J, White LR, et al.  Thiazide diuretic agents and the incidence of hip fracture . N Engl J Med. 1990;;322:286-290.
5 +
Ray WA, Griffin MR, Downey W, Melton LJ.  Long-term use of thiazide diuretics and risk of hip fracture . Lancet . 1989;;1:687-690.
6 +
Adland-Davenport P, McKenzie MW, Notelovitz M, McKenzie LC, Pendergast JF.  Thiazide diuretics and bone mineral content in postmenopausal women . Am J Obstet Gynecol. 1985;;152: 630-634.
7 +
Kiel DP, Felson DT, Anderson JJ, Wilson PWF, Moskowitz MA.  Hip fracture and the use of estrogens in postmenopausal women: the Framingham Study . N Engl J Med. 1987;;317:1169-1174.
8 +
Felson DT, Anderson JJ, Hannan MT, Milton R, Kiel D.  Impaired vision and hip fracture: the Framingham Study . J Am Geriatr Soc. 1989;;37: 495-500.
9 +
Felson DT, Kiel DP, Anderson JJ, Kannel WB.  Alcohol consumption and hip fractures: the Framingham Study . Am J Epidemiol. 1988;;128:1102-1110.
10 +
Kiel DP, Felson DT, Hannan MT, Anderson JJ, Wilson PWF.  Caffeine intake and the risk of hip fracture:the Framingham Study . Am J Epidemiol. 1990;;132:675-684.
11 +
Hastings RP, ed. SUGI Supplemental Library User's Guide . 5th ed. Cary, NC: SAS Institute Inc; 1986;.
12 +
Heaney RP, Gallagher JC, Johnston CC, et al.  Calcium nutrition and bone health in the elderly . Am J Clin Nutr. 1982;;36:986-1013.
13 +
Riggs BL, Wahner HW, Melton LJ III, Richelson LS, Judd HL, O'Fallon WM.  Dietary calcium intake and rates of bone loss in women . J Clin Invest. 1987;;80:979-982.

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1 +
Ljunghall S, Backman U, Danielson BG, Fellstrom B, Johnsson G, Wikstrom B.  Calcium and magnesium metabolism during long-term treatment with thiazides . Scand J Urol Nephrol. 1981;;15:257-262.
2 +
Wasnich RD, Benfante RJ, Yano K, Heilburn L, Vogel JM.  Thiazide effect on the mineral content of bone . N Eng J Med. 1983;;309:344-346.
3 +
Transbol I, Christensen MS, Jensen GF, Christiansen C, McNair P.  Thiazide for postponement of postmenopausal bone loss . Metabolism . 1982;;31: 383-386.
4 +
LaCroix AZ, Wienpahl J, White LR, et al.  Thiazide diuretic agents and the incidence of hip fracture . N Engl J Med. 1990;;322:286-290.
5 +
Ray WA, Griffin MR, Downey W, Melton LJ.  Long-term use of thiazide diuretics and risk of hip fracture . Lancet . 1989;;1:687-690.
6 +
Adland-Davenport P, McKenzie MW, Notelovitz M, McKenzie LC, Pendergast JF.  Thiazide diuretics and bone mineral content in postmenopausal women . Am J Obstet Gynecol. 1985;;152: 630-634.
7 +
Kiel DP, Felson DT, Anderson JJ, Wilson PWF, Moskowitz MA.  Hip fracture and the use of estrogens in postmenopausal women: the Framingham Study . N Engl J Med. 1987;;317:1169-1174.
8 +
Felson DT, Anderson JJ, Hannan MT, Milton R, Kiel D.  Impaired vision and hip fracture: the Framingham Study . J Am Geriatr Soc. 1989;;37: 495-500.
9 +
Felson DT, Kiel DP, Anderson JJ, Kannel WB.  Alcohol consumption and hip fractures: the Framingham Study . Am J Epidemiol. 1988;;128:1102-1110.
10 +
Kiel DP, Felson DT, Hannan MT, Anderson JJ, Wilson PWF.  Caffeine intake and the risk of hip fracture:the Framingham Study . Am J Epidemiol. 1990;;132:675-684.
11 +
Hastings RP, ed. SUGI Supplemental Library User's Guide . 5th ed. Cary, NC: SAS Institute Inc; 1986;.
12 +
Heaney RP, Gallagher JC, Johnston CC, et al.  Calcium nutrition and bone health in the elderly . Am J Clin Nutr. 1982;;36:986-1013.
13 +
Riggs BL, Wahner HW, Melton LJ III, Richelson LS, Judd HL, O'Fallon WM.  Dietary calcium intake and rates of bone loss in women . J Clin Invest. 1987;;80:979-982.

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