The National Prescribing Service (NPS) has provided funds to divisions of general practice to employ facilitators. These facilitators visit general practitioners to discuss common prescribing problems. During their visits the facilitators are finding some interesting issues. Australian Prescriber will publish some of these findings from time to time.

Thiazides and fractures

Some doctors are reluctant to prescribe thiazide diuretics. They fear that these drugs may put their patients at risk of having an osteoporotic fracture.

There has not been a randomised-controlled trial of the effect of thiazides on fractures. Some observational studies show a 60% increase in risk, while others show a 70% reduction in risk. To try to resolve the issue, researchers at the Garvan Institute in Sydney conducted a meta-analysis.1

The meta-analysis included 13 studies involving a total of 29 600 patients. It found that patients currently taking thiazides were less likely to have a hip fracture. The odds ratio (OR) was 0.82 with a confidence interval (CI) of 0.73-0.91. There was a trend for a reduction in all types of osteoporotic fracture (OR 0.88, CI 0.77-1.02).

While the odds of hip fracture were reduced with long-term use, short-term use of thiazides appeared to increase the fracture risk. This may be a result of patients having a fall when treatment begins.

Thiazides may influence the risk of fracture by decreasing the excretion of calcium. The authors of the meta-analysis suggest that thiazides should be considered as a method of preventing osteoporotic fractures particularly in patients with hypertension.


  1. Jones G, Nguyen T, Sambrook PN, Eisman JA. Thiazide diuretics and fractures: can meta-analysis help? J Bone Miner Res 1995;10:106-11.