Cauley J A, Cummings S R, Seeley D G, Black D, Browner W, Kuller L H, Nevitt M C
Department of Epidemiology, University of Pittsburgh, PA 15261.
Ann Intern Med. 1993 May 1;118(9):666-73. doi: 10.7326/0003-4819-118-9-199305010-00002.
To determine the relation between the use of thiazide diuretics and bone mass, fractures, and falls in older women.
Cross-sectional study of thiazide diuretics, bone mass, and prevalent vertebral deformities; cohort analysis of thiazide diuretics and nonspinal fractures and falls.
Four clinical centers located in Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; and the Monongahela Valley, Pennsylvania.
A total of 9704 ambulatory, nonblack women who were 65 years or older.
Information on thiazide use, demographic data, medical history, and anthropometric measurements were obtained by questionnaire, interview, and examination. Appendicular bone mass was measured by single-photon absorptiometry. Incident falls and fractures were ascertained every 4 months.
Women using thiazide diuretics for more than 10 years had significantly higher bone mass than women who had never used thiazide diuretics (for example, 0.381 g/cm2 compared with 0.355 g/cm2 for the distal radius [P < 0.001]). Current users of thiazide diuretics had an incidence of falls (relative risk, 1.06; 95% CI, 0.90 to 1.25) that was similar to that of those who had never used these drugs. After adjusting for age, body weight, functional status, total calcium intake, duration of estrogen replacement therapy, and self-reported health status, we found that current users of thiazide diuretics who had taken these drugs for more than 10 years had a risk for nonspinal (relative risk, 0.99; CI, 0.81 to 1.20) and osteoporotic (relative risk, 0.98; CI, 0.79 to 1.22) fractures that was similar to that of women who had never used thiazides; however, thiazide users did have a lower risk for fractures of the hip (relative risk, 0.63; CI, 0.34 to 1.16) and wrist (relative risk, 0.66; CI, 0.40 to 1.08), neither of which was significant.
Thiazide diuretics have no effect on a women's risk for falling or for experiencing nonspinal fractures. The trend toward a lower risk for hip and wrist fractures is consistent with findings in previous cohort studies but may reflect selection factors for the use of thiazide diuretics. A randomized trial is needed to determine the effect ot thiazide diuretics on the incidence of fractures.
确定噻嗪类利尿剂的使用与老年女性骨量、骨折及跌倒之间的关系。
关于噻嗪类利尿剂、骨量及椎体畸形患病率的横断面研究；关于噻嗪类利尿剂与非脊柱骨折及跌倒的队列分析。
位于马里兰州巴尔的摩、明尼苏达州明尼阿波利斯、俄勒冈州波特兰以及宾夕法尼亚州莫农加希拉谷的四个临床中心。
共计9704名65岁及以上的非黑人门诊女性。
通过问卷调查、访谈及检查获取有关噻嗪类药物使用情况、人口统计学数据、病史及人体测量数据。采用单光子吸收法测量四肢骨量。每4个月确定一次跌倒及骨折事件。
使用噻嗪类利尿剂超过10年的女性骨量显著高于从未使用过噻嗪类利尿剂的女性（例如，桡骨远端骨量分别为0.381 g/cm²和0.355 g/cm² [P < 0.001]）。目前使用噻嗪类利尿剂的女性跌倒发生率（相对风险，1.06；95%可信区间，0.90至1.25）与从未使用过此类药物的女性相似。在对年龄、体重、功能状态、总钙摄入量、雌激素替代治疗持续时间及自我报告的健康状况进行校正后，我们发现使用噻嗪类利尿剂超过10年的现使用者发生非脊柱骨折（相对风险，0.99；可信区间，0.81至1.20）和骨质疏松性骨折（相对风险，0.98；可信区间，0.79至1.22）的风险与从未使用过噻嗪类药物的女性相似；然而，噻嗪类药物使用者髋部骨折（相对风险，0.63；可信区间，0.34至1.16）和腕部骨折（相对风险，0.66；可信区间，0.40至1.08）的风险较低，但差异均无统计学意义。
噻嗪类利尿剂对女性跌倒风险及非脊柱骨折风险无影响。髋部和腕部骨折风险降低的趋势与既往队列研究结果一致，但可能反映了使用噻嗪类利尿剂的选择因素。需要进行一项随机试验来确定噻嗪类利尿剂对骨折发生率的影响。
