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Thiazide Diuretics and the Risk for Hip Fracture

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; and Bruno H.Ch. Stricker, MB, PhD
[+] Article and Author Information

From Erasmus MC, Rotterdam, the Netherlands; PHARMO Institute, Utrecht, the Netherlands; and Inspectorate for Health Care, The Hague, the Netherlands.


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.


Ann Intern Med. 2003;139(6):476-482. doi:10.7326/0003-4819-139-6-200309160-00010
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Eighty-four participants died and 8 participants had an incident hip fracture before 1 June 1991. Therefore, the study sample included 7891 participants. During a total follow-up of 58 009 person-years, 281 hip fractures occurred. Table 1 shows baseline characteristics for the participants with hip fractures and the entire study sample, as well as the percentage of missing values for the variables. When included in a Cox proportional-hazards model with age and sex, body mass index, lower-limb disability, current smoking, and estrogen use caused a change in the point estimate of 5% or more. These variables were therefore included in the final model. At baseline, thiazide users were more likely to be disabled; have a history of dizziness, diabetes mellitus, and frequent falling; and have had previous fractures in the past 5 years, but these factors did not change the point estimate by 5% or more.

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Figure.
Hazard ratios and 95% CIs for hip fracture with use of thiazide diuretics.P

All estimates were adjusted for age, sex, body mass index, lower-limb disability, current smoking, and estrogen use. * = 0.05 for trend of current use.

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Summary for Patients

Thiazide Diuretics and Hip Fracture Risk

The summary below is from the full report titled “Thiazide Diuretics and the Risk for Hip Fracture.” It is in the 16 September 2003 issue of Annals of Internal Medicine (volume 139, pages 476-482). The authors are M.W.C.J. Schoofs, M. van der Klift, A. Hofman, C.E.D.H. de Laet, R.M.C. Herings, T. Stijnen, H.A.P. Pols, and B.H.Ch. Stricker.

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Reduced fracture risk in users of thiazide diuretics. Calcif Tissue Int 2005;76(3):167-75.
Thiazide diuretics and the risk of hip fracture. Cochrane Database Syst Rev 2011;(10):CD005185.
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