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Can ß-Blockers and Thiazides Reduce Risk for Fractures?

Results from a case-control study suggest they can, but the clinical value of this finding is uncertain.

Both thiazide diuretics and ß-blockers potentially are protective against fractures: Thiazides increase calcium balance by reducing urinary calcium excretion, and adrenergic blockade inhibits bone resorption in vitro and increases bone formation in animals. In this study, researchers analyzed ß-blocker and thiazide prescription records from a large U.K. database. A total of 30,601 cases (age range, 30-79; 60% women) with new fracture diagnoses from 1993 through 1999 were compared with 120,819 controls, matched by age, sex, date, and practice. Of the fractures, 57% were in the hand, lower arm, or foot. Current use of ß-blockers or thiazides was defined as use within 59 days before fracture diagnosis.

Current use of ß-blockers on a long-term basis (receipt of 20 or more prescriptions) was associated with significantly lower fracture risk (odds ratio, 0.83) than was use of neither ß-blockers nor thiazides. Analogous odds ratios were 0.80 for use of thiazides alone and 0.71 for use of both drugs. Findings were similar for people who had received 3 to 19 prescriptions. These analyses were adjusted for demographic and clinical factors and for use of 14 other major classes of medications.

Comment: Although statistically significant and interesting, these findings have uncertain clinical value because of the limitations of case-control methodology. But, if prospective controlled studies corroborate these results, we'll have one more reason to consider thiazides and ß-blockers when we choose antihypertensive agents.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine October 1, 2004

Citation(s):

Schlienger RG et al. Use of ß-blockers and risk of fractures. JAMA 2004 Sep 15; 292:1326-32.

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