Thiazide use is associated with reduced risk for incident lower extremity fractures in men with spinal cord injury

Arch Phys Med Rehabil. 2014 Jun;95(6):1015-20. doi: 10.1016/j.apmr.2013.12.013. Epub 2013 Dec 28.

Abstract

Objective: To determine the association between thiazide use and lower extremity fractures in patients who are men with a spinal cord injury (SCI).

Design: Cohort study from fiscal years 2002 to 2007.

Setting: Medical centers.

Participants: Men (N=6969) with an SCI from the Veterans Affairs (VA) Spinal Cord Dysfunction (SCD) Registry, including 1433 users of thiazides and 5536 nonusers of thiazides.

Intervention: Thiazide use versus nonuse.

Main outcome measure: Incident lower extremity fractures.

Results: Among the men, 21% in the VA SCD Registry (fiscal years 2002-2007) included in these analyses used thiazide diuretics. There were 832 incident lower extremity fractures over the time period of this study: 110 fractures (7.7%) in 1433 thiazide users and 722 fractures (13%) in 5536 nonusers of thiazides. In unadjusted and adjusted models alike, thiazide use was associated with at least a one-quarter risk reduction in lower extremity fracture at any given point in time (unadjusted: hazard ratio (HR)=.75; 95% confidence interval (CI), .59-.94; adjusted: HR=.74; 95% CI, .58-.95).

Conclusions: Thiazide use is common in men with SCI and is associated with a decreased likelihood for lower extremity fractures.

Keywords: Fractures, bone; Men; Rehabilitation; Spinal cord injuries; Thiazides.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Age Factors
  • Aged
  • Analysis of Variance
  • Causality
  • Cohort Studies
  • Comorbidity
  • Confidence Intervals
  • Follow-Up Studies
  • Fractures, Bone / epidemiology*
  • Fractures, Bone / prevention & control
  • Hospitals, Veterans
  • Humans
  • Incidence
  • Injury Severity Score
  • Lower Extremity / injuries
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Sodium Chloride Symporter Inhibitors / therapeutic use*
  • Spinal Cord Injuries / diagnosis
  • Spinal Cord Injuries / drug therapy*
  • Spinal Cord Injuries / epidemiology
  • Spinal Cord Injuries / rehabilitation

Substances

  • Sodium Chloride Symporter Inhibitors