Osteoporosis is a major chronic condition worldwide, and the major health issue in the USA especially in the aging population.
Thiazide diuretic may decrease the risk of fracture, indicating
the protective effect of this class in clinical practice.
Osteoporosis is a major chronic condition worldwide, and the
major health issue in the USA especially in the aging population. About 300,000
people aged 65 and older are hospitalized each year due to hip fracture, a
situation which often leads to decreased quality of life. It is estimated that
there will be 50% increase in the annual fracture and the medical expenses
associated with it by 2025 as compared to 2005.
Hypertension is also a common chronic condition that often
is present in patients with osteoporosis. The prevalence of hypertension had
increased about 33.5% from the past 20 years. Thiazide diuretics have been the
most recommended drugs for hypertension treatment. Thiazide diuretic being used
in several heart conditions such as stroke, heart attack, and heart failure. It
acts by lowering the blood pressure on the kidneys and the intestines and
reduce the urinary excretion of calcium. Besides, thiazide diuretic also
reported being beneficial in decreasing the risk of osteoporotic fractures.
Due to the association of hypertension and osteoporosis and
the extensive use of thiazide diuretics for antihypertensive treatment,
understanding the effect of thiazide diuretics on bone structure, especially
concerning fracture, becomes extremely important.
Rationale behind the research:
A comprehensive review and meta-analysis of prospective cohort
studies in order to investigate the association of between thiazide diuretic
use and fracture risk is not available.
Therefore, Xiao X et al conducted a meta-analysis to
quantitatively assess all eligible prospective cohort studies that have
examined the effect of using thiazide diuretics on the risk of fracture.
Objective:
To examine the association between the use of thiazide diuretics
and the risk of fracture.
Study outcome measures:
Time period: NA
Study Outcomes:
Meta-analysis:
Subgroup
analysis:
Publication bias:
The Xiao
et al. included data from 11 qualified prospective cohort studies that
investigated the relationship between thiazide diuretics use and the risk of
fracture. The results showed 14% decrease in fracture risk in thiazide diuretic
users compared to that in nonusers. The combined meta-analysis also showed a
significant association between thiazides use and lower risk of fracture. A
pooled study in 2011 fluctuated little after four recent reviews were added,
suggesting that the addition of further investigations would have limited
impact on the overall estimate.
Additionally,
when the studies were arranged chronologically, the 95% CIs were also found to
be increasingly narrower. Which further demonstrated the robustness and
accuracy of our overall finding.
The
results of this meta-analysis were consistent with prior meta-analyses. Results
of sensitivity analysis also suggest a stronger negative association between
thiazide diuretic use and risk of hip fracture. The rates of bone loss differ
between the anatomic regions. For example, the hip is less affected by
degenerative changes and is thus more sensitive to bone loss. Therefore,
thiazide diuretic use may convey a more protective effect in increasing BMD at
the hip and hence lower the risk of hip fracture.
Hormone
replacement therapy is a common choice for fracture prevention because the
treatment inhibits bone resorption. Related research has demonstrated that
women using both thiazides and estrogen have higher BMD when compared to women
using the only thiazide. In this meta-analysis, after adjusting the protective
effect from hormone replacement therapy, a lower effect size of thiazide
diuretics was observed, compared to the pooled effect size of studies that did
not control for hormone replacement therapy.
Two main
physiological explanations for the beneficial effect of thiazide diuretics on
fracture risk were; thiazide diuretics slowed bone loss and thiazide diuretics
facilitate intestinal calcium absorption and skeletal retention of calcium. In
addition, the beneficial effect of thiazide diuretics on bone density to
decrease fracture risk could also potentially be offset by the increased
incidence of falls caused by the medicine’s side effects, which include
dizziness, blurred vision, and weakness, especially in the elderly.
The use of thiazide diuretics can decrease
the risk of fracture. However, since the variance was observed in the subgroup
analysis, further investigation is warranted.
Using thiazide diuretics as anti-hypertensive treatment and osteoporotic
fracture prevention should be prescribed with necessary caution.
Osteoporosis Int. 2018 Mar 25
Thiazide Diuretic Usage and Risk of Fracture: A Meta-Analysis of Cohort Studies
X Xiao et al.
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