Risk of hip fracture among older people using antihypertensive drugs: a nationwide cohort study

BMC Geriatrics

Anders Engeland²  Lars B. Engesæter³  Steinar Hunskaar⁴  Anette H. Ranhoff⁵  Marit S. Bakken¹  Sabine Ruths⁶ 

[1] Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Deaconess Hospital, Bergen, Norway;Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway;Norwegian Arthroplasty Registry, Department of Orthopaedics, Haukeland University Hospital, Bergen, Norway;National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway;Department of Clinical Science, University of Bergen, Bergen, Norway;Research Unit for General Practice, Uni Research Health, Bergen, Norway

关键词: Fall;    Bone mineral density;    Antihypertensive drugs;    Hip fracture;    Older people;   

Others  :  1234581
DOI  :  10.1186/s12877-015-0154-5

 received in 2015-07-05, accepted in 2015-11-23,  发布年份 2015

【 摘 要 】

Background

Many people with a high risk of hip fracture have coexisting cardiovascular diseases. We aimed to examine associations between exposure to antihypertensive drugs and the risk of hip fracture among older people.

Methods

We conducted a cohort study of the 906,422 people born before 1945 and living in Norway in 2005. We obtained information on all prescriptions of antihypertensive drugs dispensed (the Norwegian Prescription Database) in 2004–2010 and the dates of primary hip fractures (the Norwegian Hip Fracture Registry) in 2005–2010. We compared the incidence rates of hip fracture during the time people were exposed and unexposed to antihypertensive drugs by calculating the standardized incidence ratio (SIR).

Results

Altogether, 39,938 people experienced a primary hip fracture (4.4 %). The risk of hip fracture was decreased among people exposed to thiazides (SIR 0.7, 95 % confidence interval (CI) 0.6–0.7), beta-blockers (SIR 0.7, 95 % CI 0.7–0.8), calcium channel blockers (SIR 0.8, 95 % CI 0.8–0.8), angiotensin II receptor blockers (SIR 0.8, 95 % CI 0.7–0.8), ACE inhibitor/thiazide combination products (SIR 0.7, 95 % CI 0.6–0.7) and angiotensin II receptor blocker/thiazide combination products (SIR 0.6, 95 % CI 0.6–0.6). Use of loop diuretics and ACE inhibitors (plain products) was associated with increased fracture risk in people born after 1924, and with decreased risk in those born before 1925. The protective associations were stronger among exposed men than among exposed women for all drugs except loop diuretics. The SIRs decreased with increasing age among exposed people, except for thiazides and angiotensin II receptor blockers.

Conclusions

We found a reduced risk of hip fracture associated with overall use of most antihypertensive drugs, but an increased risk with loop diuretics and ACE inhibitors among people younger than 80 years and in new users of loop diuretics. This may have great impact at the population level, because the use of antihypertensive drugs is widespread in people at risk of hip fracture. Clinical studies are needed to further explore these associations.

【 授权许可】

   
2015 Ruths et al.

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