Thiazide diuretics and risk of knee replacement surgery among patients with knee osteoarthritis: a general population-based cohort study

J Wei; T Neogi; R Terkeltaub; A Z Fenves; C Zeng; D Misra; H K Choi; G Lei; Y Zhang

doi:10.1016/j.joca.2019.05.020

Thiazide diuretics and risk of knee replacement surgery among patients with knee osteoarthritis: a general population-based cohort study

Osteoarthritis Cartilage. 2019 Oct;27(10):1454-1461. doi: 10.1016/j.joca.2019.05.020. Epub 2019 Jun 8.

Authors

J Wei¹, T Neogi², R Terkeltaub³, A Z Fenves⁴, C Zeng⁵, D Misra⁶, H K Choi⁷, G Lei⁸, Y Zhang⁹

Affiliations

¹ Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: JWEI6@mgh.harvard.edu.
² Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA. Electronic address: tneogi@bu.edu.
³ Department of Medicine, University of California at San Diego, San Diego, CA, USA; VA San Diego Medical Center, San Diego, CA, USA. Electronic address: rterkeltaub@ucsd.edu.
⁴ Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: AFENVES@mgh.harvard.edu.
⁵ Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China. Electronic address: CZENG6@mgh.harvard.edu.
⁶ Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: demisra@bu.edu.
⁷ Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: hchoi@partners.org.
⁸ Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China. Electronic address: lei_guanghua@csu.edu.cn.
⁹ Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: yzhang108@mgh.harvard.edu.

PMID: 31181261
DOI: 10.1016/j.joca.2019.05.020

Abstract

Objective: Thiazide diuretic use is associated with higher bone mineral density (BMD) and possibly lower serum magnesium levels than loop diuretic use, and both high BMD and low serum magnesium have been linked to high prevalent knee osteoarthritis. This study aimed to compare the risk of a clinically relevant endpoint, knee replacement (KR) surgery, among initiators of thiazide and loop diuretics.

Design: Among patients aged ≥50 years with a diagnosis of knee osteoarthritis in The Health Improvement Network (THIN) in United Kingdom, we conducted a propensity score-matched cohort study to examine the relation of thiazide diuretic initiation vs loop diuretic initiation to the risk of KR over 5 years.

Results: Among thiazide and loop diuretic initiators (n = 3,488 for each group; mean age: 73 years; female ratio: 59%), 359 (28.6/1,000 person-years) and 283 (24.1/1,000 person-years) KRs occurred during the follow-up period, respectively. The hazard ratio (HR) of KR for thiazide diuretic initiation vs loop diuretic initiation was 1.26 (95% confidence interval [CI]: 1.08-1.47). The adherence-adjusted HR of KR for continuous use of thiazide diuretics was 1.44 (95% CI: 1.21-1.72).

Conclusions: In this population-based cohort of patients with knee osteoarthritis, thiazide diuretic use was associated with a higher risk of KR than loop diuretic use. This association may potentially be due to thiazide diuretics' effect on BMD and serum magnesium.

Keywords: Cohort; Diuretics; Knee replacement; Osteoarthritis.

Publication types

Comparative Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Aged
Arthroplasty, Replacement, Knee / statistics & numerical data*
Cohort Studies
Female
Humans
Male
Osteoarthritis, Knee / surgery*
Propensity Score
Risk Assessment
Risk Factors
Sodium Chloride Symporter Inhibitors / adverse effects*
Sodium Potassium Chloride Symporter Inhibitors / adverse effects*

Substances

Sodium Chloride Symporter Inhibitors
Sodium Potassium Chloride Symporter Inhibitors

Abstract

Publication types

MeSH terms

Substances

Grants and funding