Thiazide Use Is Associated With Reduced Risk for Incident Lower Extremity Fractures in Men With Spinal Cord Injury

ObjectiveTo determine the association between thiazide use and lower extremity fractures in patients who are men with a spinal cord injury (SCI).DesignCohort study from fiscal years 2002 to 2007.SettingMedical centers.ParticipantsMen (N=6969) with an SCI from the Veterans Affairs (VA) Spinal Cord Dysfunction (SCD) Registry, including 1433 users of thiazides and 5536 nonusers of thiazides.InterventionThiazide use versus nonuse.Main Outcome MeasureIncident lower extremity fractures.ResultsAmong the men, 21% in the VA SCD Registry (fiscal years 2002–2007) included in these analyses used thiazide diuretics. There were 832 incident lower extremity fractures over the time period of this study: 110 fractures (7.7%) in 1433 thiazide users and 722 fractures (13%) in 5536 nonusers of thiazides. In unadjusted and adjusted models alike, thiazide use was associated with at least a one-quarter risk reduction in lower extremity fracture at any given point in time (unadjusted: hazard ratio (HR)=.75; 95% confidence interval (CI), .59–.94; adjusted: HR=.74; 95% CI, .58–.95).ConclusionsThiazide use is common in men with SCI and is associated with a decreased likelihood for lower extremity fractures.