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Osteoporosis International

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01-07-2018 | Original Article

Thiazide diuretic usage and risk of fracture: a meta-analysis of cohort studies

Authors: X. Xiao, Y. Xu, Q. Wu

Published in: Osteoporosis International | Issue 7/2018

Abstract

Summary

Inconsistent findings in regard to association between thiazide diuretic use and the risk of fracture have been reported during the past decade. This updated meta-analysis, which pooled data from 11 qualified prospective designed studies, found that thiazides have a significant protective effect on fracture risk.

Introduction

An updated comprehensive meta-analysis examine the association between thiazide diuretic use and therisk of fracture is needed.

Methods

Cohort studies regarding thiazide diuretic exposure and the risk of fracture, published from inception to May 1 2017, were identified through MEDLINE, EMBASE, SCOPUS, and the Cochrane Database of Systematic Reviews. The literature search, study selection, study appraisal, and data extraction were pre-defined in the protocol and were independently conducted by two investigators. Due to the heterogeneity of the original studies, a random effects model was used to pool the confounder-adjusted relative risk (RR).

Results

Eleven eligible cohort studies involving 2,193,160 participants were included for analysis. Overall, thiazide diuretic users, as compared with non-users, had a significant 14% reduction in the risk of all fractures (relative risk [RR], 0.86; 95% confidence interval [CI], 0.80–0.93; p = 0.009) and an 18% reduction in the risk of hip fracture (RR, 0.82; 95%CI, 0.80–0.93; p = 0.009). However, the effect size associated with thiazide use became slightly weaker when the analysis was limited to only high-quality original studies (quality score > 8) (RR, 0.89; 95%CI, 0.80–0.99; p = 0.005), studies with a larger sample size (> 10,000) (RR, 0.90; 95%CI, 0.80–1.00; p = 0.002), and studies published after 2007 (RR, 0.92; 95%CI, 0.82–1.02; p = 0.001).

Conclusion

Our findings indicate that thiazide diuretic use may convey a decreased risk of fracture and as such, the protective effect of this class of medicine should be considered when prescribing thiazide diuretics in clinical practice.

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Title: Thiazide diuretic usage and risk of fracture: a meta-analysis of cohort studies
Authors: X. Xiao
Y. Xu
Q. Wu
Publication date: 01-07-2018
Publisher: Springer London
Published in: Osteoporosis International / Issue 7/2018
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-018-4486-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Thiazide diuretic usage and risk of fracture: a meta-analysis of cohort studies

Abstract

Summary

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

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