Thiazide diuretics and risk of knee replacement surgery among patients with knee osteoarthritis: a general population-based cohort study.

Abstract

OBJECTIVE:

Thiazide diuretic use is associated with higher bone mineral density (BMD) and possibly lower serum magnesium levels than loop diuretic use, and both high BMD and low serum magnesium have been linked to high prevalent knee osteoarthritis. This study aimed to compare the risk of a clinically relevant endpoint, knee replacement (KR) surgery, among initiators of thiazide and loop diuretics.

DESIGN:

Among patients aged ≥50 years with a diagnosis of knee osteoarthritis in The Health Improvement Network (THIN) in United Kingdom, we conducted a propensity score-matched cohort study to examine the relation of thiazide diuretic initiation vs loop diuretic initiation to the risk of KR over 5 years.

RESULTS:

Among thiazide and loop diuretic initiators (n = 3,488 for each group; mean age: 73 years; female ratio: 59%), 359 (28.6/1,000 person-years) and 283 (24.1/1,000 person-years) KRs occurred during the follow-up period, respectively. The hazard ratio (HR) of KR for thiazide diuretic initiation vs loop diuretic initiation was 1.26 (95% confidence interval [CI]: 1.08-1.47). The adherence-adjusted HR of KR for continuous use of thiazide diuretics was 1.44 (95% CI: 1.21-1.72).

CONCLUSIONS:

In this population-based cohort of patients with knee osteoarthritis, thiazide diuretic use was associated with a higher risk of KR than loop diuretic use. This association may potentially be due to thiazide diuretics' effect on BMD and serum magnesium.

• Authors: J Wei, T Neogi, R Terkeltaub, A Z Fenves, C Zeng, D Misra, H K Choi, G Lei, Y Zhang
• Journal: Osteoarthritis and cartilage (Osteoarthritis Cartilage) Vol. 27 Issue 10 Pg. 1454-1461 (10 2019) ISSN: 1522-9653 [Electronic] England
• PMID: 31181261 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: Copyright © 2019 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Sodium Chloride Symporter Inhibitors
• Sodium Potassium Chloride Symporter Inhibitors

Topics

• Aged
• Arthroplasty, Replacement, Knee (statistics & numerical data)
• Cohort Studies
• Female
• Humans
• Male
• Osteoarthritis, Knee (surgery)
• Propensity Score
• Risk Assessment
• Risk Factors
• Sodium Chloride Symporter Inhibitors (adverse effects)
• Sodium Potassium Chloride Symporter Inhibitors (adverse effects)