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Continuous and long-term treatment is more important than dosage for the protective effect of thiazide use on bone metabolism and fracture risk

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Standard

Continuous and long-term treatment is more important than dosage for the protective effect of thiazide use on bone metabolism and fracture risk. / Kruse, C; Eiken, P; Vestergaard, P.

I: Journal of Internal Medicine, Bind 279, Nr. 1, 01.2016, s. 110-22.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

Harvard

Kruse, C, Eiken, P & Vestergaard, P 2016, 'Continuous and long-term treatment is more important than dosage for the protective effect of thiazide use on bone metabolism and fracture risk', Journal of Internal Medicine, bind 279, nr. 1, s. 110-22. https://doi.org/10.1111/joim.12397

APA

Kruse, C., Eiken, P., & Vestergaard, P. (2016). Continuous and long-term treatment is more important than dosage for the protective effect of thiazide use on bone metabolism and fracture risk. Journal of Internal Medicine, 279(1), 110-22. https://doi.org/10.1111/joim.12397

Vancouver

Kruse C, Eiken P, Vestergaard P. Continuous and long-term treatment is more important than dosage for the protective effect of thiazide use on bone metabolism and fracture risk. Journal of Internal Medicine. 2016 jan;279(1):110-22. https://doi.org/10.1111/joim.12397

Author

Kruse, C ; Eiken, P ; Vestergaard, P. / Continuous and long-term treatment is more important than dosage for the protective effect of thiazide use on bone metabolism and fracture risk. I: Journal of Internal Medicine. 2016 ; Bind 279, Nr. 1. s. 110-22.

Bibtex

@article{622c938f82a047cfa1b932d7500efcb6,
title = "Continuous and long-term treatment is more important than dosage for the protective effect of thiazide use on bone metabolism and fracture risk",
abstract = "BACKGROUND: Data from observational studies have suggested that thiazide diuretics protect against fractures. Few studies have investigated time frames from initiation of treatment to fracture occurrence.OBJECTIVE: To evaluate the time to spinal, hip, femur, wrist and upper extremity fracture occurrence before and after thiazide exposure.METHODS: A matched retrospective cohort study of patient information from national Danish patient databases was conducted. Patients with reimbursed prescriptions for noncompounded thiazide diuretics with potassium supplementation (Anatomical Therapeutic Chemical classification system code C03AB) between 1996 and 2011 were matched with nonexposed control subjects by date of birth and gender. Weekly odds ratios (ORs) of fracture occurrence and total incidence rates (IRs) and incidence rate ratios (IRRs) of fracture risk were calculated for the periods before treatment initiation, weeks 1-42 and weeks 43-780.RESULTS: A total of 1,602,141 'thiazide exposure periods' (46,8271 individuals) and 1,530,233 'nonexposure periods' (655,399 individuals) were included in the analysis. Thiazide use was associated with factors of increased de novo fracture risk. Weekly adjusted fracture risk between exposure and nonexposure was increased prior to commencing thiazide therapy, further increasing from weeks 1-42 weeks and then decreasing gradually from weeks 43-780. There was a decreasing trend in total age-adjusted risk during these periods: IRR [95{\%} confidence interval 1.44 [1.42; 1.47], 1.27 [1.24; 1.29] and 1.14 [1.11; 1.18], respectively. Prescription patterns showed several treatment breaks amongst thiazide users.CONCLUSIONS: It appears that thiazides reduce the background risk of fracture that is increased prior to commencing therapy. Long duration and continuity of thiazide exposure seems to be important to obtain this protective effect on fracture risk, but we have found in this study that this approach is not always used in clinical practice.",
keywords = "Aged, Bone and Bones, Cohort Studies, Comorbidity, Databases as Topic, Female, Fractures, Bone, Humans, Male, Retrospective Studies, Sodium Chloride Symporter Inhibitors, Journal Article",
author = "C Kruse and P Eiken and P Vestergaard",
note = "{\circledC} 2015 The Association for the Publication of the Journal of Internal Medicine.",
year = "2016",
month = "1",
doi = "10.1111/joim.12397",
language = "English",
volume = "279",
pages = "110--22",
journal = "Acta Medica Scandinavica",
issn = "0955-7873",
publisher = "Wiley-Blackwell",
number = "1",

}

RIS

TY - JOUR

T1 - Continuous and long-term treatment is more important than dosage for the protective effect of thiazide use on bone metabolism and fracture risk

AU - Kruse, C

AU - Eiken, P

AU - Vestergaard, P

N1 - © 2015 The Association for the Publication of the Journal of Internal Medicine.

PY - 2016/1

Y1 - 2016/1

N2 - BACKGROUND: Data from observational studies have suggested that thiazide diuretics protect against fractures. Few studies have investigated time frames from initiation of treatment to fracture occurrence.OBJECTIVE: To evaluate the time to spinal, hip, femur, wrist and upper extremity fracture occurrence before and after thiazide exposure.METHODS: A matched retrospective cohort study of patient information from national Danish patient databases was conducted. Patients with reimbursed prescriptions for noncompounded thiazide diuretics with potassium supplementation (Anatomical Therapeutic Chemical classification system code C03AB) between 1996 and 2011 were matched with nonexposed control subjects by date of birth and gender. Weekly odds ratios (ORs) of fracture occurrence and total incidence rates (IRs) and incidence rate ratios (IRRs) of fracture risk were calculated for the periods before treatment initiation, weeks 1-42 and weeks 43-780.RESULTS: A total of 1,602,141 'thiazide exposure periods' (46,8271 individuals) and 1,530,233 'nonexposure periods' (655,399 individuals) were included in the analysis. Thiazide use was associated with factors of increased de novo fracture risk. Weekly adjusted fracture risk between exposure and nonexposure was increased prior to commencing thiazide therapy, further increasing from weeks 1-42 weeks and then decreasing gradually from weeks 43-780. There was a decreasing trend in total age-adjusted risk during these periods: IRR [95% confidence interval 1.44 [1.42; 1.47], 1.27 [1.24; 1.29] and 1.14 [1.11; 1.18], respectively. Prescription patterns showed several treatment breaks amongst thiazide users.CONCLUSIONS: It appears that thiazides reduce the background risk of fracture that is increased prior to commencing therapy. Long duration and continuity of thiazide exposure seems to be important to obtain this protective effect on fracture risk, but we have found in this study that this approach is not always used in clinical practice.

AB - BACKGROUND: Data from observational studies have suggested that thiazide diuretics protect against fractures. Few studies have investigated time frames from initiation of treatment to fracture occurrence.OBJECTIVE: To evaluate the time to spinal, hip, femur, wrist and upper extremity fracture occurrence before and after thiazide exposure.METHODS: A matched retrospective cohort study of patient information from national Danish patient databases was conducted. Patients with reimbursed prescriptions for noncompounded thiazide diuretics with potassium supplementation (Anatomical Therapeutic Chemical classification system code C03AB) between 1996 and 2011 were matched with nonexposed control subjects by date of birth and gender. Weekly odds ratios (ORs) of fracture occurrence and total incidence rates (IRs) and incidence rate ratios (IRRs) of fracture risk were calculated for the periods before treatment initiation, weeks 1-42 and weeks 43-780.RESULTS: A total of 1,602,141 'thiazide exposure periods' (46,8271 individuals) and 1,530,233 'nonexposure periods' (655,399 individuals) were included in the analysis. Thiazide use was associated with factors of increased de novo fracture risk. Weekly adjusted fracture risk between exposure and nonexposure was increased prior to commencing thiazide therapy, further increasing from weeks 1-42 weeks and then decreasing gradually from weeks 43-780. There was a decreasing trend in total age-adjusted risk during these periods: IRR [95% confidence interval 1.44 [1.42; 1.47], 1.27 [1.24; 1.29] and 1.14 [1.11; 1.18], respectively. Prescription patterns showed several treatment breaks amongst thiazide users.CONCLUSIONS: It appears that thiazides reduce the background risk of fracture that is increased prior to commencing therapy. Long duration and continuity of thiazide exposure seems to be important to obtain this protective effect on fracture risk, but we have found in this study that this approach is not always used in clinical practice.

KW - Aged

KW - Bone and Bones

KW - Cohort Studies

KW - Comorbidity

KW - Databases as Topic

KW - Female

KW - Fractures, Bone

KW - Humans

KW - Male

KW - Retrospective Studies

KW - Sodium Chloride Symporter Inhibitors

KW - Journal Article

U2 - 10.1111/joim.12397

DO - 10.1111/joim.12397

M3 - Journal article

C2 - 26223424

VL - 279

SP - 110

EP - 122

JO - Acta Medica Scandinavica

JF - Acta Medica Scandinavica

SN - 0955-7873

IS - 1

ER -

ID: 164155699