Thiazide-Type Diuretics May Reduce the Risk of Fractures

Use of thiazide-type diuretics to treat hypertension may reduce the risk of hip and pelvic fractures compared with other antihypertensive medications, according to a new analysis.

Although observational studies have found that thiazide diuretics may reduce fracture risk, results from clinical trials are lacking.
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To conduct a secondary analysis of a randomized clinical trial, the researchers used Veterans Affairs and Medicare claims data, as well as data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, to identify patients who were hospitalized with a hip or pelvic fracture from February 1994 to January 1998.

The researchers followed 22,180 patients who were randomly assigned to receive a thiazide-type diuretic (chlorthalidone), a calcium channel blocker (amlodipine besylate), or an angiotensin-converting enzyme inhibitor (lisinopril) for up to 8 years.

After the study period, the researchers continued to follow 16,622 participants, who had claims data available, for another 5 years.

Adjusted analyses showed that chlorthalidone was associated with a significantly lower risk of fracture compared with amlodipine and lisinopril.

Secondary analysis that included post-trial data showed similar results, although the lower risk was not statistically significant.

“These findings from a large randomized clinical trial provide evidence of a beneficial effect of thiazide-type diuretic therapy in reducing hip and pelvic fracture risk compared with treatment with other antihypertensive medications,” the researchers concluded.

—Amanda Balbi

Reference:

Puttnam R, Davis BR, Pressel SL, et al; the Antihypertensive and Lipid-Lowering Treatment to Protect Heart Attack Trial (ALLHAT) Collaborative Research Group. Association of 3 different antihypertensive medications with hip and pelvic fracture risk in older adults: secondary analysis of a randomized clinical trial [published online November 21, 2016]. JAMA Intern Med. doi:10.1001/jamainternmed.2016.6821.