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Increased incidence of hip fracture after first prescription for antihypertensive drugs

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7840 (Published 21 November 2012) Cite this as: BMJ 2012;345:e7840

Just over 300 000 older adults started drug treatments for hypertension in Ontario, Canada, between 2000 and 2009. Researchers identified 1463 hip fractures in the same cohort during the same period. They also identified a significantly increased risk of fracture in the 45 days immediately after a first prescription (incidence rate ratio 1.43, 95% CI 1.19 to 1.72). Angiotensin converting enzyme inhibitors, β blockers, and thiazide diuretics were the three most prevalent treatments, followed by calcium channel blockers and angiotensin receptor blockers. Researchers combined all drug classes for their main analyses, which compared fracture incidence in the 45 days immediately after the start of treatment with control periods both before and after the first 45 days of treatment. Individuals acted as their own controls. Mean age at hip fracture was 80.8 years. Most fractures occurred in women (80.7%).

Other researchers have already reported a higher risk of falls after drug treatments for hypertension, say the authors. So an association with hip fractures isn’t unexpected. Nine out of 10 hip fractures are preceded by falls, and orthostatic hypotension caused by antihypertensive drugs is a plausible culprit for both. Doctors should be aware of the possibility of early falls and fractures in older people who start taking these drugs, say the authors, and they should exercise caution until we know more.

Notes

Cite this as: BMJ 2012;345:e7840