Hip Fracture Risk Briefly Rises on Loop Diuretics



SAN DIEGO – The risk of hip fracture nearly doubles during the week following a new prescription for a loop diuretic.

In contrast, there is no spike in the risk of hip fracture in the 7 days following a new prescription for other classes of diuretics or for ACE inhibitors, according to an analysis of the massive The Health Improvement Network (THIN) database involving more than 400 U.K. primary care practices.

The most likely explanation for the short-term jump in risk of hip fracture may be related to the prominent urinary symptoms that often accompany a new prescription for loop diuretics. The resultant rush to the bathroom could lead to an increased rate of falls during that initial adjustment period, Dr. Sarah D. Berry speculated at the annual meeting of the American Society for Bone and Mineral Research.

She reported on 28,703 subjects who experienced an incident hip fracture and more than 2 million others who did not during 15.1 million person-years of follow-up recorded in the THIN primary care database. In a nested, case-crossover study, she and her coworkers compared the occurrence of new diuretic prescriptions in the 7 days prior to the hip fracture to the occurrence of new diuretic prescriptions during the control period 31-37 days before the fracture.

The adjusted odds ratio of an incident hip fracture was significantly increased by 80% during the 7 days following a new prescription for a loop diuretic. That being said, it needs to be emphasized that the absolute risk during this week-long window of increased vulnerability remained low: 2.9 hip fractures per 100,000 new loop diuretic prescriptions, according to Dr. Berry of the Hebrew SeniorLife Institute for Aging Research and Beth Israel Deaconess Medical Center, Boston.

Counseling vulnerable older adults and their caregivers about the need for increased awareness and careful ambulation to the bathroom during the 7 days after going on a loop diuretic might help reduce hip fractures, she added.

Dr. Berry declared having no financial conflicts regarding the study, which was supported by the U.S. National Institutes of Health and Hebrew SeniorLife.

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