Exploring Therapies to Reduce Pelvic and Hip Fractures

The thiazide diuretic chlorthalidone is associated with a reduced risk of pelvic and hip fractures compared with other antihypertensive drugs, according to a new analysis of the ALLHAT study. Nearly 22,000 men and women (57% and 43%, respectively) were followed for up to eight years during masked therapy and more than 16,600 were followed for an additional five years. During the trial, 338 fractures occurred. Patients randomized to chlorthalidone vs. amlodipine or lisinopril demonstrated a lower risk of fracture on adjusted analysis (hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.63-0.89; P = 0.04). The risk of fracture was significantly lower with chlorthalidone vs. lisinopril (HR, 0.75; P = 0.04) but not amlodipine (HR, 0.82; P = 0.17). These findings “provide evidence of a beneficial effect of thiazide-type diuretic therapy in reducing hip and pelvic fracture risk compared with treatment with other antihypertensive medications.” This study strengthens evidence from other studies that suggested that thiazides improve bone strength and reduce fracture risk by exerting a positive effect on calcium balance and perhaps a direct stimulatory effect on osteoblasts. (JAMA Intern Med. Published online Nov. 21, 2016. doi:10.1001/jamainternmed.2016.6821)