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Antihypertensive therapy initiation in the elderly increases hip fracture risk


This large case series study of elderly Canadian patients (n=301,591) investigated whether initiation of hypertensive therapy led to a significant increase in hip fracture incidence.

The patients were all community based and the rate of hip fractures in the first 45 days of their hypertensive therapy was compared with the rate observed during subsequent 45-day periods of antihypertensive therapy and with 45-day periods when no therapy was in place.

The findings were clear; a total of 1,463 hip fractures occurred in the first 45-day period and analysis showed that the population as a whole was at a 43% increased risk of sustaining a hip fracture during this initial period of anti-hypertensive treatment compared with control periods (incidence rate ratio 1.43; 95% confidence interval 1.19–1.72). There were no significant differences in risk according to drug; 30.1% of patients were prescribed angiotensin II converting enzyme inhibitors, 25.5% beta blockers, 23% thiazide diuretics, 17% calcium channel blockers and 4.4% angiotensin II receptor blockers.

Editor’s comment: Antihypertensive medication is a well-known risk factor for falls; however, its immediate contribution to hip fracture risk in the elderly is unknown. This study demonstrated that antihypertensives cause an early and up to 50% increase in hip fracture risk, without major differences among various classes of medication. This observation should prompt evaluation and management of falls and fracture risk in elderly patients newly diagnosed with hypertension.

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