Use of α-blockers and the risk of hip/femur fractures

Authors

  • P. C. Souverein,

    1. From the Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
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  • T. P. Van Staa,

    1. From the Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
    2. Medical Research Council, Environmental Epidemiology Unit, Southampton University Hospital, Southampton, UK
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  • A. C. G. Egberts,

    1. From the Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
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  • J. J. M. C. H. De la Rosette,

    1. Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
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  • C. Cooper,

    1. Medical Research Council, Environmental Epidemiology Unit, Southampton University Hospital, Southampton, UK
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  • H. G. M. Leufkens

    1. From the Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
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P.C. Souverein, Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, PO Box 80082, 3508 TB Utrecht, The Netherlands (fax: +31 30 253 9166; e-mail: p.c.souverein@pharm.uu.nl).

Abstract.

Objective.  To study the association between use of α-blockers and risk of hip/femur fractures.

Design.  Population-based case–control study.

Setting.  General Practice Research Database.

Subjects.  Cases were defined as men, aged 40 years and older with a first diagnosis for hip/femur fracture. Controls were matched 1 : 1 on gender, year of birth and general practitioner-practice.

Results.  In all, 4571 cases and an equal number of controls were identified. Current use of α-blockers (prazosin, doxazosin, indoramin, terazosin, alfuzosin and tamsulosin) was compared with non-use of α-blockers. Current use of α-blockers on the index date was associated with an increased risk of hip/femur fracture [adjusted odds ratio (OR) 1.9, 95% confidence interval (CI): 1.1–3.0] in the overall analysis. The effect was particularly strong for first prescriptions within a treatment episode (adjusted OR 5.1, 95% CI: 1.0–31.7) and during the first month of treatment (adjusted OR 4.1, 95% CI: 0.7–23.9). Stratification according to indication of use showed that current use of α-blockers was not associated with hip/femur fracture in men with a diagnosis of benign prostatic hyperplasia (adjusted OR 1.0, 95% CI: 0.4–2.5), but was associated in men who used α-blockers for cardiovascular disease (adjusted OR 2.8, 95% CI: 1.4–5.4).

Conclusion.  Current use of α-blockers was associated with an increased risk of hip/femur fracture and with the start of a new treatment episode. The effect seemed to be confined to patients who used α-blockers for cardiovascular disease. Caution with respect to first-dose effects related to the initiation of a new episode of α-blocker treatment is advised.

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