A beneficial effect of thiazide-type diuretic therapy was observed in the reduction of hip and pelvic fracture risk in older adults compared with other antihypertensive medications, a recent study found. The study examined hip and pelvic fracture hospitalizations in Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants randomized to first-step therapy with a thiazide-type diuretic (chlorthalidone), a calcium channel blocker (amlodipine besylate), or an angiotensin-converting enzyme inhibitor (lisinopril). Recruitment was from February 1994 to January 1998 with follow-up ending in March 2002. Researchers found:

• 22,180 participants (mean age, 70.4 years; 43.0% female; 49.9% white non-Hispanic; 31.2% African American) were followed for up to 8 years.
• 338 fractures occurred during the trial.
• Those randomized to receive chlorthalidone vs amlodipine or lisinopril had a lower risk of fracture on adjusted analysis (HR, 0.79).
• Risk of fracture was significantly lower in those randomized to receive chlorthalidone vs lisinopril (HR, 0.75), but not significantly different compared with those randomized to receive amlodipine (HR, 0.82).
• Cumulative incidence of fractures was nonsignificantly lower in participants randomized to receive chlorthalidone vs lisinopril or amlodipine (HR, 0.87).