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Use of organic nitrates has been associated with increased bone mineral density. Moreover, a large Danish case-control study reported a decreased fracture risk. However, the association with duration of nitrate use, dose frequency, and impact of discontinuation has not been extensively studied.Our objective was to evaluate the association between organic nitrates and hip fracture risk.A case-control study was conducted using the Dutch PHARMO Record Linkage System (1991-2002, n = 6,763 hip fracture cases and 26,341 controls). Cases had their first admission for hip fracture, whereas controls had not sustained any fracture after enrollment. Current users of organic nitrates were patients who had received a prescription within 90 d before the index date. The analyses were adjusted for disease and drug history.Current use of nitrates was not associated with a decreased risk of hip fracture [adjusted odds ratio (OR) = 0.93; 95% confidence interval (CI) = 0.83-1.04]. Those who used as-needed medication only had a lower risk of hip fracture (adjusted OR = 0.83; 95% CI = 0.63-1.08) compared with users of maintenance medication only (adjusted OR = 1.17; 95% CI = 0.97-1.40). No association was found between duration of nitrate use and fracture risk.Our overall analyses showed that risk of a hip fracture was significantly lower among users of as-needed organic nitrates, when compared with users of maintenance medication. Our analyses of hip fracture risks with duration of use did not further support a beneficial effect of organic nitrates on hip fracture, although residual confounding may have masked beneficial effects.

Original publication

DOI

10.1210/jc.2009-2342

Type

Journal article

Journal

The Journal of clinical endocrinology and metabolism

Publication Date

04/2010

Volume

95

Pages

1924 - 1931

Addresses

Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Pharmacotherapy, University Utrecht, 3508 TB Utrecht, The Netherlands.

Keywords

Humans, Hip Fractures, Nitrates, Nitroglycerin, Isosorbide Dinitrate, Vasodilator Agents, Epidemiologic Methods, Odds Ratio, Risk, Case-Control Studies, Adolescent, Adult, Aged, Middle Aged, Population, Female, Male, Young Adult