Loop diuretic use and fracture in postmenopausal women: Findings from the women's health initiative

Laura D. Carbone, Karen C. Johnson, Andrew J. Bush, John Robbins, Joseph C. Larson, Asha Thomas, Andrea Z. Lacroix

Research output: Contribution to journalArticle

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Abstract

Background: The relationship of loop diuretics to bone mineral density (BMD), falls, and fractures in postmenopausal women has not been established. Methods: We examined whether loop diuretics are associated with changes in BMD, falls, and fractures in women enrolled in the Women's Health Initiative. We included the 133 855 women (3411 users and 130 444 nonusers of loop diuretics) who were enrolled in the WHI from October 29, 1993 to December 31, 1998 and determined incident falls and fractures for a mean of 7.7 years. Women who had BMD measurements at baseline and at year 3 (300 users and 9124 nonusers of loop diuretics) were also examined. Results: After adjustment for covariates, no significant association was found between ever use of loop diuretics and total (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.00-1.19), hip (HR, 1.21; 95% CI, 0.91-1.60), and clinical vertebral fractures (HR, 1.17; 95% CI, 0.92-1.48) and falls (1.02; 0.96-1.08). An increased risk was found for other clinical fractures (1.16; 1.01-133) and total fractures (1.16; 1.03-1.31) with more than 3 years' use of loop diuretics. The BMD changes were not associated with loop diuretic use. Conclusions: After adjustment for confounding variables, no significant association was found between ever use of loop diuretics and changes in BMD, falls, and fractures. Loop diuretics were used by women in poor health who were already at risk for fractures. However, prolonged use of loop diuretics was associated with higher fracture risk in postmenopausal women.

Original languageEnglish (US)
Pages (from-to)132-140
Number of pages9
JournalArchives of Internal Medicine
Volume169
Issue number2
DOIs
StatePublished - Jan 26 2009
Externally publishedYes

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Sodium Potassium Chloride Symporter Inhibitors
Women's Health
Bone Density
Confidence Intervals
Confounding Factors (Epidemiology)
Hip

ASJC Scopus subject areas

  • Internal Medicine

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Loop diuretic use and fracture in postmenopausal women : Findings from the women's health initiative. / Carbone, Laura D.; Johnson, Karen C.; Bush, Andrew J.; Robbins, John; Larson, Joseph C.; Thomas, Asha; Lacroix, Andrea Z.

In: Archives of Internal Medicine, Vol. 169, No. 2, 26.01.2009, p. 132-140.

Research output: Contribution to journalArticle

Carbone, Laura D. ; Johnson, Karen C. ; Bush, Andrew J. ; Robbins, John ; Larson, Joseph C. ; Thomas, Asha ; Lacroix, Andrea Z. / Loop diuretic use and fracture in postmenopausal women : Findings from the women's health initiative. In: Archives of Internal Medicine. 2009 ; Vol. 169, No. 2. pp. 132-140.
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abstract = "Background: The relationship of loop diuretics to bone mineral density (BMD), falls, and fractures in postmenopausal women has not been established. Methods: We examined whether loop diuretics are associated with changes in BMD, falls, and fractures in women enrolled in the Women's Health Initiative. We included the 133 855 women (3411 users and 130 444 nonusers of loop diuretics) who were enrolled in the WHI from October 29, 1993 to December 31, 1998 and determined incident falls and fractures for a mean of 7.7 years. Women who had BMD measurements at baseline and at year 3 (300 users and 9124 nonusers of loop diuretics) were also examined. Results: After adjustment for covariates, no significant association was found between ever use of loop diuretics and total (hazard ratio [HR], 1.09; 95{\%} confidence interval [CI], 1.00-1.19), hip (HR, 1.21; 95{\%} CI, 0.91-1.60), and clinical vertebral fractures (HR, 1.17; 95{\%} CI, 0.92-1.48) and falls (1.02; 0.96-1.08). An increased risk was found for other clinical fractures (1.16; 1.01-133) and total fractures (1.16; 1.03-1.31) with more than 3 years' use of loop diuretics. The BMD changes were not associated with loop diuretic use. Conclusions: After adjustment for confounding variables, no significant association was found between ever use of loop diuretics and changes in BMD, falls, and fractures. Loop diuretics were used by women in poor health who were already at risk for fractures. However, prolonged use of loop diuretics was associated with higher fracture risk in postmenopausal women.",
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AB - Background: The relationship of loop diuretics to bone mineral density (BMD), falls, and fractures in postmenopausal women has not been established. Methods: We examined whether loop diuretics are associated with changes in BMD, falls, and fractures in women enrolled in the Women's Health Initiative. We included the 133 855 women (3411 users and 130 444 nonusers of loop diuretics) who were enrolled in the WHI from October 29, 1993 to December 31, 1998 and determined incident falls and fractures for a mean of 7.7 years. Women who had BMD measurements at baseline and at year 3 (300 users and 9124 nonusers of loop diuretics) were also examined. Results: After adjustment for covariates, no significant association was found between ever use of loop diuretics and total (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.00-1.19), hip (HR, 1.21; 95% CI, 0.91-1.60), and clinical vertebral fractures (HR, 1.17; 95% CI, 0.92-1.48) and falls (1.02; 0.96-1.08). An increased risk was found for other clinical fractures (1.16; 1.01-133) and total fractures (1.16; 1.03-1.31) with more than 3 years' use of loop diuretics. The BMD changes were not associated with loop diuretic use. Conclusions: After adjustment for confounding variables, no significant association was found between ever use of loop diuretics and changes in BMD, falls, and fractures. Loop diuretics were used by women in poor health who were already at risk for fractures. However, prolonged use of loop diuretics was associated with higher fracture risk in postmenopausal women.

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