Loop diuretic use and rates of hip bone loss and risk of falls and fractures in older women.

摘要

OBJECTIVES: To determine whether loop diuretic use is associated with hip bone loss and greater risk of falls and fractures in older women. DESIGN: Prospective cohort study from August 1992 to April 2004. SETTING: Four regions in the United States from the Study of Osteoporotic Fractures (SOF). PARTICIPANTS: Women aged 65 and older (N=8,127) with medication use data who participated in the fourth SOF examination, from which three study cohorts were derived. MEASUREMENTS: Bone mineral density (BMD) of the total hip assessed using dual-energy X-ray absorptiometry at the fourth and sixth examinations (n=2,980); recurrent (> or =2) falls in the year after the fourth examination (n=6,244); and incident fracture, including nonspine (n=6,778) and hip fracture (n=7,272). RESULTS: After multivariable adjustment, loop diuretic users had greater loss of total hip BMD than nonusers (mean annualized % BMD -0.87 vs -0.71, P=.03) after a mean of 4.4+/-0.6 years. The risks of recurrent falls (odds ratio=0.99, 95% confidence interval (CI)=0.71-1.39), nonspine (relative risk (RR)=1.04, 95% CI=0.90-1.21), and hip fracture (RR=1.03, 95% CI=0.81-1.31) were not greater in loop diuretic users than in nonusers. CONCLUSION: In this cohort of older women, loop diuretic use was associated with a small but significantly higher rate of hip bone loss than nonuse after a mean duration of 4.4 years, although the risk of falls or fracture did not differ between the two groups.