Mariette W.C.J. Schoofs, MD, MSc; Marjolein van der Klift, PhD; Albert Hofman, MD, PhD; Chris E.D.H. de Laet, MD, PhD; Ron M.C. Herings, PharmD, PhD; Theo Stijnen, PhD; Huibert A.P. Pols, MD, PhD; Bruno H.Ch. Stricker, MB, PhD
Acknowledgments: The authors thank the people of the Rotterdam Study for participation and the research physicians and assistants of the Rotterdam Study for data collection.
Grant Support: No external funding was obtained for this study.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Bruno H.Ch. Stricker, MB, PhD, Department of Epidemiology and Biostatistics, Erasmus MC, PO Box 1738, 3000 DR Rotterdam, the Netherlands.
Current Author Addresses: Drs. Schoofs, Hofman, Stijnen, and Stricker: Department of Epidemiology and Biostatistics, Erasmus MC, PO Box 1738, 3000 DR, Rotterdam, the Netherlands.
Drs. van der Klift and Pols: Department of Internal Medicine, Erasmus MC, PO Box 1738, 3000 DR, Rotterdam, the Netherlands.
Dr. de Laet: Department of Public Health, Erasmus MC, PO Box 1738, 3000 DR, Rotterdam, the Netherlands.
Dr. Herings: Prismant, Maliebaan 50, 3581 CS, Utrecht, the Netherlands.
Author Contributions: Conception and design: M.W.C.J. Schoofs, R.M.C. Herings, H.A.P. Pols, B.H.Ch. Stricker.
Analysis and interpretation of the data: M.W.C.J. Schoofs, A. Hofman, T. Stijnen, H.A.P. Pols, B.H.Ch. Stricker.
Drafting of the article: M.W.C.J. Schoofs, R.M.C. Herings, H.A.P. Pols, B.H.Ch. Stricker.
Critical revision of the article for important intellectual content: M. van der Klift, A. Hofman, C.E.D.H. de Laet, R.M.C. Herings, H.A.P. Pols, B.H.Ch. Stricker.
Final approval of the article: M.W.C.J. Schoofs, A. Hofman, H.A.P. Pols, B.H.Ch. Stricker.
Provision of study materials or patients: A. Hofman, H.A.P. Pols.
Statistical expertise: T. Stijnen, B.H.Ch. Stricker.
Obtaining of funding: B.H.Ch. Stricker.
Administrative, technical, or logistic support: H.A.P. Pols, B.H.Ch. Stricker.
Collection and assembly of data: M.W.C.J. Schoofs, M. van der Klift, A. Hofman, C.E.D.H. de Laet, R.M.C. Herings, H.A.P. Pols, B.H.Ch. Stricker.
Since most hip fractures are related to osteoporosis, treating accelerated bone loss can be an important strategy to prevent hip fractures. Thiazides have been associated with reduced age-related bone loss by decreasing urinary calcium excretion.
To examine the association between dose and duration of thiazide diuretic use and the risk for hip fracture and to study the consequences of discontinuing use.
Prospective population-based cohort study.
The Rotterdam Study.
7891 individuals 55 years of age and older.
Hip fractures were reported by the general practitioners and verified by trained research assistants. Details of all dispensed drugs were available on a day-to-day basis. Exposure to thiazides was divided into 7 mutually exclusive categories: never use, current use for 1 to 42 days, current use for 43 to 365 days, current use for more than 365 days, discontinuation of use since 1 to 60 days, discontinuation of use since 61 to 120 days, and discontinuation of use since more than 120 days.
281 hip fractures occurred. Relative to nonuse, current use of thiazides for more than 365 days was statistically significantly associated with a lower risk for hip fracture (hazard ratio, 0.46 [95% CI, 0.21 to 0.96]). There was no clear dose dependency. This lower risk disappeared approximately 4 months after thiazide use was discontinued.
Thiazide diuretics protect against hip fracture, but this protective effect disappears within 4 months after use is discontinued.
Schoofs MW, van der Klift M, Hofman A, de Laet CE, Herings RM, Stijnen T, et al. Thiazide Diuretics and the Risk for Hip Fracture. Ann Intern Med. ;139:476–482. doi: 10.7326/0003-4819-139-6-200309160-00010
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Published: Ann Intern Med. 2003;139(6):476-482.
Cardiology, Coronary Risk Factors, Endocrine and Metabolism, Hypertension, Metabolic Bone Disorders.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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