Osteoporotic fracture risks of thiazides and dihydropyridines in angiotensin modulator users
Main finding · TOPFResult — go to the resultHazard ratio 0.65 95% CI 0.61–0.70Authors' conclusion
Thiazides are associated with lower risks of typical osteoporotic fractures compared to DHP drugs in patients treated with ACEi or ARB, while such benefits may diminish in those with a diagnosis of inflammatory polyarthropathy and benzodiazepine usage.
Study context
- Population
- Hypertensive angiotensin-converting enzyme inhibitor (ACEi) or ARB users under thiazide or dihydropyridine (DHP) treatment, 2015–2022, US TriNetX; predominantly white54,240 per cohort post-PSM
- Participants
- 54,240 vs 54,240
- Exposure
- Thiazide plus ACEi or ARB vs DHP plus ACEi or ARB
- Thiazide-ACEi/ARBn = 54,240
- DHP-ACEi/ARBn = 54,240reference
- Outcome
- Composite typical osteoporotic fracture (TOPF)
- Follow-up
- 5-year follow-up
Methodological details1:1 propensity-score matched, TriNetX US Collaborative Network, 5-year follow-up, Kaplan Meier analyses
- 1:1 propensity-score matched
- TriNetX US Collaborative Network
- 5-year follow-up
- Kaplan Meier analyses
Main finding
TOPF
Hazard ratio
0.65
95% CI 0.61–0.70
Thiazide-ACEi/ARBvs DHP-ACEi/ARB
HR 0.65 (95% CI 0.61–0.70)
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | HR | P value |
|---|---|---|
| TOPF, ACEi vs ARB users (subgroups)Thiazide-ACEi/ARB vs DHP-ACEi/ARB · ACEi users | 0.69 | |
| TOPF, ACEi vs ARB users (subgroups)Thiazide-ACEi/ARB vs DHP-ACEi/ARB · ARB users | 0.67 | Cochran's Q-test p-value = 0.78 |
Heterogeneity of thiazide effect by inflammatory polyarthropathy (ICD-10 M05-M14) and benzodiazepine usage
- Significant heterogeneity by inflammatory polyarthropathy, Cochran's Q-test p-value
- 0.01
- Significant heterogeneity by benzodiazepine usage, Cochran's Q-test p-value
- 0.04
Original publication
Osteoporotic fracture risks of thiazides and dihydropyridines in angiotensin modulator users. Osteoporos Int. Published 27 December 2024. doi:10.
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