Loop diuretic use and rates of hip bone loss and risk of falls and fractures in older women.

OBJECTIVES

To determine whether loop diuretic use is associated with hip bone loss and greater risk of falls and fractures in older women.

DESIGN

Prospective cohort study from August 1992 to April 2004.

SETTING

Four regions in the United States from the Study of Osteoporotic Fractures (SOF).

PARTICIPANTS

Women aged 65 and older (N=8,127) with medication use data who participated in the fourth SOF examination, from which three study cohorts were derived.

MEASUREMENTS: Bone mineral density (BMD) of the total hip assessed using dual-energy X-ray absorptiometry at the fourth and sixth examinations (n=2,980); recurrent (> or =2) falls in the year after the fourth examination (n=6,244); and incident fracture, including nonspine (n=6,778) and hip fracture (n=7,272).

RESULTS

After multivariable adjustment, loop diuretic users had greater loss of total hip BMD than nonusers (mean annualized % BMD -0.87 vs -0.71, P=.03) after a mean of 4.4+/-0.6 years. The risks of recurrent falls (odds ratio=0.99, 95% confidence interval (CI)=0.71-1.39), nonspine (relative risk (RR)=1.04, 95% CI=0.90-1.21), and hip fracture (RR=1.03, 95% CI=0.81-1.31) were not greater in loop diuretic users than in nonusers.

CONCLUSION

In this cohort of older women, loop diuretic use was associated with a small but significantly higher rate of hip bone loss than nonuse after a mean duration of 4.4 years, although the risk of falls or fracture did not differ between the two groups.