SynthesisOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2018
Thiazide diuretic usage and risk of fracture: a meta-analysis of cohort studies.
Synthesis in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
18 citing papers in PubMed, 3 syntheses or guidelines pooled it, 40 citations in OpenAlex.
- Association of β-adrenergic receptor blockers use with the risk of fracture in adults: a systematic review and meta-analysis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Pooled it
- Thiazide Use and Fracture Risk: An updated Bayesian Meta-Analysis.Scientific reports · 2019Pooled it
- Thiazide Diuretics and the Incidence of Osteoporotic Fracture: A Systematic Review and Meta-Analysis of Cohort Studies.Frontiers in pharmacology · 2019Pooled it
- Bone microarchitectural degradation in hypertensive patients: a population-based study.Archives of osteoporosis · 2026Article
- Clinical and genetic features of Gitelman syndrome patients with hyperuricemia.Clinical kidney journal · 2025Article
- Hydrochlorothiazide and Bone Mineral Density in Patients with Kidney Stones: Post Hoc Analysis of the NOSTONE Trial.Clinical journal of the American Society of Nephrology : CJASN · 2025Article
- Osteoporotic fracture risks of thiazides and dihydropyridines in angiotensin modulator users.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- Interrelationships among metabolic syndrome, bone-derived cytokines, and the most common metabolic syndrome-related diseases negatively affecting bone quality.Diabetology & metabolic syndrome · 2024Review
- Incident Diuretic Use and Subsequent Risk of Bone Fractures: A Large Nationwide Observational Study of US Veterans.Mayo Clinic proceedings · 2024Observational
- Angiotensin II receptor blockers and bone fracture in chronic kidney disease patients: the Fukuoka kidney disease Registry Study.Clinical and experimental nephrology · 2023Observational
- Thiazide Diuretics and Fracture Risk: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.JBMR plus · 2022Article
- Association of Thiazide Use in Patients with Hypertension with Overall Fracture Risk: A Population-Based Cohort Study.Journal of clinical medicine · 2022Article
- The Effects of Osteoporotic and Non-osteoporotic Medications on Fracture Risk and Bone Mineral Density.Drugs · 2021Review
- Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review).Journal of clinical medicine · 2020Review
- Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study.BMC geriatrics · 2020Article
- Association of Receiving Multiple, Concurrent Fracture-Associated Drugs With Hip Fracture Risk.JAMA network open · 2019Article
- Long-term thiazide use and risk of low-energy fractures among persons with Alzheimer's disease-nested case-control study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2019Article
- Incidence of Lower-Extremity Fractures in US Nursing Homes.Journal of the American Geriatrics Society · 2019Article
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Inconsistent findings in regard to association between thiazide diuretic use and the risk of fracture have been reported during the past decade. This updated meta-analysis, which pooled data from 11 qualified prospective designed studies, found that thiazides have a significant protective effect on fracture risk.
introductionAn updated comprehensive meta-analysis examine the association between thiazide diuretic use and therisk of fracture is needed.
methodsCohort studies regarding thiazide diuretic exposure and the risk of fracture, published from inception to May 1 2017, were identified through MEDLINE, EMBASE, SCOPUS, and the Cochrane Database of Systematic Reviews. The literature search, study selection, study appraisal, and data extraction were pre-defined in the protocol and were independently conducted by two investigators. Due to the heterogeneity of the original studies, a random effects model was used to pool the confounder-adjusted relative risk (RR).
resultsEleven eligible cohort studies involving 2,193,160 participants were included for analysis. Overall, thiazide diuretic users, as compared with non-users, had a significant 14% reduction in the risk of all fractures (relative risk [RR], 0.86; 95% confidence interval [CI], 0.80-0.93; p = 0.009) and an 18% reduction in the risk of hip fracture (RR, 0.82; 95%CI, 0.80-0.93; p = 0.009). However, the effect size associated with thiazide use became slightly weaker when the analysis was limited to only high-quality original studies (quality score > 8) (RR, 0.89; 95%CI, 0.80-0.99; p = 0.005), studies with a larger sample size (> 10,000) (RR, 0.90; 95%CI, 0.80-1.00; p = 0.002), and studies published after 2007 (RR, 0.92; 95%CI, 0.82-1.02; p = 0.001).
conclusionOur findings indicate that thiazide diuretic use may convey a decreased risk of fracture and as such, the protective effect of this class of medicine should be considered when prescribing thiazide diuretics in clinical practice.
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