Laxative use and incident falls, fractures and change in bone mineral density in postmenopausal women: results from the Women's Health Initiative
Wyler, von Ballmoos
AffiliationDepartment of Internal Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Oberdürrbacher Strasse 6, Würzburg, 97080, Germany
Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
Arizona Cancer Center, University of Arizona, Tucson, Arizona, USA
Department of Social and Preventive Medicine, University at Buffalo, SUNY School of Public Health and Health Professions, Buffalo, NY, USA
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
Department of Surgery & Division of Cardiothoracic Surgery, Froedtert Memorial Hospital & Medical College of Wisconsin, Milwaukee, WI, USA
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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CitationHaring et al. BMC Geriatrics 2013, 13:38 http://www.biomedcentral.com/1471-2318/13/38
Rights© 2013 Haring et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0)
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AbstractBACKGROUND:Laxatives are among the most widely used over-the-counter medications in the United States but studies examining their potential hazardous side effects are sparse. Associations between laxative use and risk for fractures and change in bone mineral density BMD] have not previously been investigated.METHODS:This prospective analysis included 161,808 postmenopausal women (8907 users and 151,497 nonusers of laxatives) enrolled in the WHI Observational Study and Clinical Trials. Women were recruited from October 1, 1993, to December 31, 1998, at 40 clinical centers in the United States and were eligible if they were 50 to 79 years old and were postmenopausal at the time of enrollment. Medication inventories were obtained during in-person interviews at baseline and at the 3-year follow-up visit on everyone. Data on self-reported falls (greater than or equal to]2), fractures (hip and total fractures) were used. BMD was determined at baseline and year 3 at 3 of the 40 clinical centers of the WHI.RESULTS:Age-adjusted rates of hip fractures and total fractures, but not for falls were similar between laxative users and non-users regardless of duration of laxative use. The multivariate-adjusted hazard ratios for any laxative use were 1.06 (95% confidence interval CI], 1.03-1.10) for falls, 1.02 (95% CI, 0.85-1.22) for hip fractures and 1.01 (95% CI, 0.96-1.07) for total fractures. The BMD levels did not statistically differ between laxative users and nonusers at any skeletal site after 3-years intake.CONCLUSION:These findings support a modest association between laxative use and increase in the risk of falls but not for fractures. Its use did not decrease bone mineral density levels in postmenopausal women. Maintaining physical functioning, and providing adequate treatment of comorbidities that predispose individuals for falls should be considered as first measures to avoid potential negative consequences associated with laxative use.
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