Alzheimer's and Fractures: Reducing Risk with Thiazide Diuretics
Thiazide diuretics reduce the risk of fractures in people with Alzheimer’s disease, according to research conducted at the University of Eastern Finland.1 Thiazides, part of the class of diuretics, are typically prescribed to treat hypertension. They have been on the market for over 60 years and are considered an efficient and cost-effective first-line choice to treat hypertension in older adults.1 The researchers believe thiazides might have a beneficial effect on bone mineral density because they decrease the excretion of urinary calcium.2 This could result in a decrease in the risk of fracture in case of a fall.1
Link between thiazides and fractures
The investigation in Finland assessed the association between taking thiazides and the risk of low-energy fractures (LEF) among people with Alzheimer’s disease.2 A low energy fracture is defined as a fracture caused by slip, trip or fall from standing height.
How the study was conducted
The study looked at cases of people diagnosed with Alzheimer’s between 2005 and 2011 in Finland. This included more than 10,000 subjects and 30,000 controls.1 Scientists considered people with fractures who had previously had an Alzheimer’s diagnosis, and who were hospitalized or treated in specialized outpatient clinics and emergency rooms. The data evaluated was from Hospital Discharge registers.2 Only one LEF event after an Alzheimer's diagnoses was considered for each person.
LEF cases were matched with up to three controls without such fractures, considering time since an Alzheimer’s diagnosis, as well as age and gender. Prescription registers were used to identify thiazide use. Thiazide use included those that were combined with other antihypertensive drugs in the same tablet.1
Findings from the study
10.5% of patients who used thiazide sustained low-energy fractures, compared to 12.5% of the control population. This decrease in risk was maximized with length of use. Longer use, greater than three years, resulted in an additional reduction in the risk of a LEF fracture.1,2
The results published in Osteoporosis International found that hip fracture was the most common LEF in the study population. The risk of hip fracture decreased by 30% with thiazide use. Shorter-term use, less than three years, did not reduce the risk of fractures. Moreover, the benefits from longer-term use were not persistent; they disappeared roughly one month after thiazide use was discontinued.
What does it all mean?
Clinical trials are not common in people with advanced age and dementia.2 There have been no prior studies on thiazide use among people with Alzheimer’s, or other forms of dementia, that investigated fracture risk as a primary outcome. The findings suggest that although thiazides are not considered a preventive therapy because of their side effects, there are implications to be considered in the selection of antihypertensive medications in this population, given that it is at increased risk for falls and fractures due to their dementia.1
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