digoxin and Fractures--Bone

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

Topics: Acute Kidney Injury; Aged; Ankle Injuries; Anti-Arrhythmia Agents; Antidotes; Digoxin; Female; Fractures, Bone; Humans; Immunoglobulin Fab Fragments; Respiratory Tract Infections; Syncope

Cardiac arrhythmias and osteoporotic fractures are common in the elderly.. We studied whether tachyarrhythmia and/or the drugs used to treat arrhythmias affect risk of fracture.. In a population-based nation-wide pharmaco-epidemiological case-control design, we compared 124,655 patients that sustained a fracture during 2000 with 373,962 age- and gender-matched controls. We used computerized registers to assess individual drug use and related these data to individual fracture data and information on confounders.. Risk of any fracture was increased in patients with atrial fibrillation [Odds ratio (OR): 1.14; 95% confidence interval (95%CI): 1.08-1.21] and in patients currently treated with amiodarone (OR: 1.47; 95%CI: 1.21-1.78). Conversely, current use of digoxin decreased fracture risk (OR: 0.75; 95%CI: 0.71-0.79). Subanalysis showed similar effects in men and in women, but drug treatment only affected fracture risk in subjects older than 65 years of age. In current users of digoxin, risk of any fracture and risk of hip and forearm fracture decreased dose-dependently with increased dose. The use of other antiarrhythmics did not affect fracture risk.. Special attention should be paid to patients on treatment with amiodarone and/or a diagnosis of atrial fibrillation as they may have an increased risk of fracture. Conversely, treatment with digoxin may reduce fracture risk.

Topics: Adult; Age Factors; Aged; Amiodarone; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Case-Control Studies; Digoxin; Dose-Response Relationship, Drug; Female; Forearm Injuries; Fractures, Bone; Hip Fractures; Humans; Male; Osteoporosis; Risk Factors; Sex Factors; Tachycardia

Topics: Arrhythmias, Cardiac; Birth Injuries; Clavicle; Digoxin; Electrocardiography; Fractures, Bone; Humans; Infant, Newborn; Obstetrical Forceps; Tachycardia, Paroxysmal