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Original article| Volume 95, ISSUE 6, P1015-1020, June 2014

Thiazide Use Is Associated With Reduced Risk for Incident Lower Extremity Fractures in Men With Spinal Cord Injury

Published:December 30, 2013DOI:https://doi.org/10.1016/j.apmr.2013.12.013

      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

      List of abbreviations:

      BZD (benzodiazepine), CI (confidence interval), FY (fiscal year), HR (hazard ratio), ICD-9 (International Statistical Classification of Diseases, 9th revision), SAS (Statistical Analysis System), SCD (Spinal Cord Dysfunction), SCI (spinal cord injury), SSRI (selective serotonin reuptake inhibitor), VA (Veterans Affairs)
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