Osteoporotic fracture risks of thiazides and dihydropyridines in angiotensin modulator users.

IF 4.2 2区医学 Q1 ENDOCRINOLOGY & METABOLISM Osteoporosis International Pub Date : 2024-12-27 DOI:10.1007/s00198-024-07356-2

Yang-Chi Lin, Ping-Hao Chiang, Jing-Yang Huang, Wen-Shiann Wu

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Abstract

This study examined the impact of thiazide and RAAS antihypertensive medications vs DHP-RAAS medications on fracture risk. The close alignment of such settings with clinical use, combined with the potential bone benefits of ACEis and ARBs, provides enhanced accuracy in bone health evidence.

Purpose: To determine whether thiazides, combined with either angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB), offer bone-protective benefits compared with dihydropyridine (DHP) drugs combined with ACEi or ARB.

Methods: This retrospective cohort study was conducted on the US Collaborative Network from the TriNetX database on March 5th, 2024. It included hypertensive ACEi or ARB users under thiazide or DHP drug treatments spanning from January 1st, 2015, to December 31st, 2022, with exclusion criteria applied. The primary outcome is a composite typical osteoporotic fracture (TOPF). Kaplan Meier analyses were performed after 1:1 propensity-score matching (PSM) with a 5-year follow-up. Besides investigating fracture-related outcomes in thiazide-ACEi/ARB and DHP-ACEi/ARB users, this study explores whether the effects differ between ACEi and ARB users. Subgroup analyses were also performed, and the heterogeneity among the results was assessed using Cochran's Q-tests.

Results: Post-PSM results yield 54,240 patients per cohort in the primary analysis, aging 61.5 ± 12.2 versus 61.4 ± 13.7 (thiazide-ACEi/ARB versus DHP-ACEi/ARB) with predominantly white ethnicity. Thiazide-ACEi/ARB users exhibit lower TOPF risk than DHP-ACEi/ARB users (hazard ratio (HR) = 0.65, 95% confidence interval (CI) 0.61-0.70), and such benefits from thiazides are similar between ACEi and ARB users (ACEi: HR = 0.69; ARB: HR = 0.67, Cochran's Q-test p-value = 0.78). Additionally, the effects of thiazides reveal significant heterogeneity between patients with and without inflammatory polyarthropathy (ICD-10, M05-M14) and benzodiazepine usage (Cochran's Q-test p-value = 0.01, 0.04).

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.

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噻嗪类和二氢吡啶类血管紧张素调节剂使用者骨质疏松性骨折的风险。

本研究考察噻嗪类和RAAS类降压药与DHP-RAAS类降压药对骨折风险的影响。这些设置与临床使用的紧密结合，结合ACEis和arb的潜在骨骼益处，提高了骨骼健康证据的准确性。目的：确定噻嗪类药物与血管紧张素转换酶抑制剂（ACEi）或血管紧张素受体阻阻剂（ARB）联合使用时，与二氢吡啶（DHP）药物与ACEi或ARB联合使用相比，是否具有骨保护作用。方法：本回顾性队列研究于2024年3月5日在TriNetX数据库的美国协作网络上进行。纳入2015年1月1日至2022年12月31日期间接受噻嗪类或DHP药物治疗的高血压ACEi或ARB使用者，并采用排除标准。主要预后为典型骨质疏松性骨折（TOPF）。Kaplan Meier分析在1:1倾向评分匹配（PSM）和5年随访后进行。除了调查噻嗪-ACEi/ARB和DHP-ACEi/ARB使用者的骨折相关结局外，本研究还探讨了ACEi和ARB使用者的影响是否存在差异。还进行了亚组分析，并使用Cochran’s q检验评估结果之间的异质性。结果：在初始分析中，psm后的结果为每个队列54,240例患者，年龄为61.5±12.2 vs 61.4±13.7（噻唑- acei /ARB vs DHP-ACEi/ARB），主要为白人。噻嗪类药物-ACEi/ARB使用者比DHP-ACEi/ARB使用者表现出更低的TOPF风险(风险比（HR) = 0.65, 95%可信区间（CI） 0.61-0.70），并且噻嗪类药物在ACEi和ARB使用者之间的获益相似(ACEi: HR = 0.69；ARB: HR = 0.67,科克伦Q-test假定值= 0.78)。此外，噻嗪类药物对炎性多关节病（ICD-10, M05-M14）和苯二氮卓类药物使用患者的影响具有显著的异质性（Cochran’s q检验p值= 0.01,0.04）。结论：与DHP药物相比，在ACEi或ARB治疗的患者中，噻嗪类药物与典型骨质疏松性骨折的风险较低相关，而在诊断为炎症性多关节病和使用苯二氮卓类药物的患者中，这种益处可能会降低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Osteoporosis International 医学-内分泌学与代谢

CiteScore

8.10

自引率

10.00%

发文量

224

审稿时长

3 months

期刊介绍： An international multi-disciplinary journal which is a joint initiative between the International Osteoporosis Foundation and the National Osteoporosis Foundation of the USA, Osteoporosis International provides a forum for the communication and exchange of current ideas concerning the diagnosis, prevention, treatment and management of osteoporosis and other metabolic bone diseases. It publishes: original papers - reporting progress and results in all areas of osteoporosis and its related fields; review articles - reflecting the present state of knowledge in special areas of summarizing limited themes in which discussion has led to clearly defined conclusions; educational articles - giving information on the progress of a topic of particular interest; case reports - of uncommon or interesting presentations of the condition. While focusing on clinical research, the Journal will also accept submissions on more basic aspects of research, where they are considered by the editors to be relevant to the human disease spectrum.