ECTS2014 Poster Presentations Osteoporosis: treatment (68 abstracts)
Association between allopurinol use and hip fracture in older patients discharged from rehabilitation
Ujani Basu 1 , James Goodbrand 1 , Marion McMurdo 1 , Peter Donnan 1 , Mark McGilchrist 1 , Helen Frost 2 , Jacob George 1 & Miles Witham 1
1University of Dundee, Dundee, UK; 2Scottish Collaboration for Public Health Research and Policy, Edinburgh, UK.
Background: Allopurinol reduces oxidative stress and interacts with purinergic signalling systems important in bone metabolism and muscle function. We assessed whether allopurinol use was associated with a reduced incidence of hip fracture in older people who had undergone rehabilitation.
Methods: Analysis of prospective, routinely-collected rehabilitation and hospitalisation data. Data on patients discharged from a single inpatient geriatric rehabilitation centre over a 12-year period were linked to community prescribing data and ICD-10 coded hospitalisation data. Exposure to allopurinol was derived from prescribing data, and hip fracture was derived from hospitalisation data. Time-dependent covariate analysis was used to model time to hip fracture, incorporating ever-use of allopurinol, cumulative exposure to allopurinol, and covariates (age, sex, Barthel Index, comorbid disease, concomitant medication and biochemistry indices)
Results: 3517 patients were alive at discharge from rehabilitation without a previous diagnosis of hip fracture; mean age 84 years. 1474 (39%) were males, and 253 (7%) had at least one exposure to allopurinol. A total of 313 (9%) sustained a hip fracture, and 2628 (75%) died during a mean follow-up of 3.1 years. In fully adjusted analyses, each year of allopurinol exposure showed a hazard ratio of 0.17 (95% CI 0.01–2.70) for hip fracture, 1.22 (0.87–1.70) for death, and 1.14 (0.81–1.61) for time to death or hip fracture. Ever-use of allopurinol was associated with a hazard ratio of 1.48 (0.75–2.91) for hip fracture, 1.48 (1.16–1.90) for death and 1.49 (1.16–1.91) for death or hip fracture.
Conclusion: Allopurinol use may be a marker of increased risk of death and hip fracture, but greater cumulative exposure to allopurinol may be associated with a reduced risk of hip fracture. Studies with more events are required to confirm or refute these initial non-significant findings
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Bone Abstracts
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