Initiation of antihypertensive therapy is associated with an increased risk of hip fracture

Abstract

Evaluation of: Butt DA, Mamdani M, Austin PC, Tu K, Gomes T, Glazier RH. The risk of hip fracture after initiating antihypertensive drugs in the elderly. Arch. Intern. Med. 172(22), 1739–1744 (2012). Previous research has identified an association between antihypertensive drugs, falls and fractures. Nearly all hip fractures are fall-related. However, little is known about the risk of hip fracture immediately after initiating an antihypertensive. Butt et al. conducted a self-controlled case series of newly treated community-dwelling older people with hypertension. The authors linked data from the Ontario Drug Benefit Program database to a series of administrative healthcare registers. There were 1463 hip fractures among the 301,591 newly treated hypertensive older people over a 10-year period. There was a 43% increased risk of hip fracture in the 45 days immediately after initiating an antihypertensive compared with the six 45-day control periods before and after treatment initiation (incidence rate ratio: 1.43; 95% CI: 1.19–1.72). The within-person study design minimized the possibility of confounding by indication, which often occurs in cohort and case–control studies. Initiating an antihypertensive may be a risk factor for hip fracture in community-dwelling older people with hypertension.