cardiovascular-agents and Fractures--Bone

During the past decade, major advances have reported the importance of the vitamin D on the bone metabolism, and recent studies have suggested the potential non skeletal effects of the vitamin D. Adequate vitamin D contributes to reduce the risk of non vertebral fractures, improves the neuromuscular function and reduces the risk of falls when serum 25OHD level are greater than 30ng/mL (75nmol/L). A possible role of vitamin D has been implicated in the reduction of mortality, of the non-skin cancers, of the risk of infections, of inflammatory diseases, of cardiovascular diseases and maybe osteoarthritis. However the current level of evidence for associations is weaker than for skeletal effects. Serum 25OHD level is influenced by several factors (cutaneous vitamin D production, fat mass, dietary sources, UV-B exposure, latitude, season...), and the measurement of the serum 25OHD level is the only way to determine the vitamin D status. It is recommended to measure the serum 25OHD level in patients with osteoporosis or at risk of osteoporosis, and to correct the deficiency.

Topics: Anti-Infective Agents; Anti-Inflammatory Agents; Antineoplastic Agents; Bone and Bones; Cardiovascular Agents; Fractures, Bone; Humans; Muscle, Skeletal; Neuromuscular Junction; Osteoarthritis; Osteoporosis; Vitamin D; Vitamins

Cardiovascular diseases are common and occur mainly in the elderly in whom osteoporotic fractures also are very common. Because of this, it is of importance to establish whether drugs used in the treatment of cardiovascular diseases affect bone, in order to minimise any possible adverse effects. In the majority of studies, treatment with thiazide diuretics, statins, digoxin, angiotensin-converting enzyme (ACE)-inhibitors, and organic nitrates have not been associated with harmful effects on bone. On the contrary, treatment with these drugs may improve bone strength but because there is a lack of randomised controlled trials (RCTs) with fracture as a primary outcome measure, these drugs should not be prescribed for fracture prevention. In RCTs, treatment with loop diuretics have been shown to increase plasma levels of parathyroid hormone and decrease bone mineral density. In epidemiological studies, treatment with loop diuretics as well as treatment with amiodarone has been associated with an increased risk of fracture. In view of the conflicting results from published studies, no conclusions can be drawn on potential bone effects of treatment with oral anticoagulants, beta-blockers, and calcium channel blockers.

Topics: Animals; Bone Density; Cardiovascular Agents; Clinical Trials as Topic; Fractures, Bone; Humans

Women frequently chose alternatives to hormone replacement therapy (HRT) for treatment of menopause even though medical indications for estrogens may be present. Prior breast cancer or fear of breast cancer is a major consideration. This review of alternatives to estrogen discusses the evidence linking breast cancer to HRTs and compares potential risks and benefits of HRT to nonHRT alternatives for relief of vasomotor symptoms, vaginal atrophy, neurocognitive changes and prevention of heart disease and osteoporosis. Practical guidelines are suggested for use of alternatives for each problem.

Topics: Aged; Antidepressive Agents; Atrophy; Bone Density; Bone Resorption; Breast Neoplasms; Calcitonin; Calcium; Cardiovascular Agents; Cardiovascular Diseases; Clinical Trials as Topic; Contraindications; Diphosphonates; Double-Blind Method; Estrogen Replacement Therapy; Estrogens; Estrogens, Non-Steroidal; Female; Fractures, Bone; Hot Flashes; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Isoflavones; Life Style; Menopause; Mental Disorders; Meta-Analysis as Topic; Middle Aged; Multicenter Studies as Topic; Osteoporosis, Postmenopausal; Phytoestrogens; Phytotherapy; Plant Preparations; Randomized Controlled Trials as Topic; Risk; Safety; Selective Estrogen Receptor Modulators; Urothelium; Vagina

Topics: Cardiovascular Agents; Fractures, Bone; Humans

To determine whether drugs used in treatment of cardiovascular diseases (CVD-drugs), including hypertension, increase the risk of fragility fractures in individuals above the age of 65 years.. Retrospective nationwide cohort study.. Danish nationwide national registers.. All individuals in Denmark ≥ 65 years who used specified CVD-drugs in the study period between 1999 and 2012.. Time-dependent exposure to CVD-drugs (nitrates, digoxin, thiazides, furosemide, ACE inhibitors, angiotensin receptor antagonists, β-blockers, calcium antagonists and statins) was determined by prescription claims from pharmacies. The association between use of specific CVD-drugs and fragility fractures was assessed using multivariable Poisson regression models, and adjusted incidence rate ratios (IRRs) were calculated.. Overall, 1,586,554 persons were included, of these 16.1% experienced a fall-related fracture. The multivariable Poisson regression analysis showed positive associations between fracture and treatment with furosemide, thiazide and digoxin. IRRs during the first 14 days of treatment were for furosemide IRR 1.74 (95% CI 1.61 to 1.89) and for thiazides IRR 1.41 (1.28 to 1.55); IRR during the first 30 days of treatment with digoxin was 1.18 (1.02 to 1.37).. Use of furosemide, thiazides and digoxin was associated with elevated rates of fragility fractures among elderly individuals. This may warrant consideration when considering diuretic treatment of hypertension in elderly individuals.

Topics: Accidental Falls; Aged; Aged, 80 and over; Cardiovascular Agents; Denmark; Digoxin; Female; Fractures, Bone; Furosemide; Humans; Hypertension; Male; Multivariate Analysis; Regression Analysis; Retrospective Studies; Risk Assessment; Risk Factors; Thiazides

The authors used 2 national Veterans Health Administration databases to identify outpatient medications and all 30 Elixhauser comorbidities for 2579 unique patients, age 65+ years, hospitalized for syncope in fiscal year 2004. For comparison, we identified other elderly patients hospitalized with acute myocardial infarction (N = 4491), fracture (N = 2797), or pneumonia (N = 9473). The categories of medications included drugs that affect the cardiovascular, central nervous, or the muscular skeletal system. The most notable differences between syncope compared to acute myocardial infarction patients occurred in central nervous system drugs in anticonvulsants/barbiturates, antidepressants, antihistamine/antinauseants, antipsychotics, and cholinesterase inhibitors (P < .0018). Comparing syncope patients with fracture patients, the central nervous medication profile was similar, but the cardiovascular medication profile differed (P < .0018); their hypertension comorbidities also differed (60.45% vs 46.34%); (P < .0016). These findings indicate significant potential associations that warrant further study. Studies linking national outpatient medications to hospitalizations for specific conditions can foster the development of more proactive pharmacovigilance systems.

Topics: Aged; Cardiovascular Agents; Central Nervous System Agents; Comorbidity; Fractures, Bone; Hospitalization; Humans; Myocardial Infarction; Outpatients; Pneumonia; Residence Characteristics; Syncope; United States; United States Department of Veterans Affairs

Topics: Accidents; Cardiovascular Agents; Fractures, Bone; Succinylcholine

Topics: Cardiovascular Agents; Fractures, Bone; Gallamine Triethiodide; Humans; Mandible; Meperidine; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Convulsive Therapy; Electroshock; Fractures, Bone; Iodides; Muscle Relaxants, Central; Succinylcholine

Topics: Cardiovascular Agents; Fractures, Bone; Humans; Joint Dislocations; Muscle Relaxants, Central