Association of Thiazide Use in Patients with Hypertension with Overall Fracture Risk: A Population-Based Cohort Study

Area of Science:

• Pharmacology
• Gerontology
• Orthopedics

Background:

• Thiazide diuretics are established antihypertensive agents.
• Beyond blood pressure reduction, thiazides influence calcium homeostasis and bone density.
• A potential benefit of thiazides in reducing fracture risk warrants investigation.

Purpose of the Study:

• To investigate the hypothesis that thiazide diuretic use in hypertensive patients reduces overall fracture risk.
• To compare fracture incidence between thiazide users and non-users among hypertensive individuals.

Main Methods:

• Retrospective cohort study using the Taiwan National Health Insurance Research Database (2000-2017).
• Patients with hypertension were classified into thiazide and nonthiazide users.
• 1:1 propensity score matching was employed, followed by multivariable Cox regression and Kaplan-Meier survival analysis.

Main Results:

• A total of 18,483 matched pairs of thiazide users and non-users were analyzed.
• Incidence densities of fractures were lower in the thiazide group (1.82 per 1000 person-months) compared to the nonthiazide group (1.99 per 1000 person-months).
• Thiazide use was associated with a significantly lower hazard ratio for fractures (aHR = 0.93, 95% CI: 0.88-0.98) and a lower cumulative incidence (log-rank test; p = 0.0012).

Conclusions:

• This study demonstrates that thiazide diuretic use is associated with a reduced risk of fractures in patients with hypertension.
• Thiazides may offer a dual benefit of blood pressure control and fracture risk reduction.
• Consideration of thiazide diuretics may be advantageous for hypertensive patients with elevated fracture risk.