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Bone mineral density loss in women who initiated antihypertensive medications during the menopausal transition in a multicenter, multiethnic, community-based cohort study: women's health across the nation (SWAN)

Zhao, Zhenping (2014) Bone mineral density loss in women who initiated antihypertensive medications during the menopausal transition in a multicenter, multiethnic, community-based cohort study: women's health across the nation (SWAN). Master Essay, University of Pittsburgh.

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Abstract

Objective: The objective of this study is to examine the association between initiating antihypertensive medications and bone mineral density (BMD) loss over time in women while transitioning through menopause. Methods: Women who initiated antihypertensive use during menopausal transition were selected from the Study of Women across the Nation. Nonusers were matched to users with two methods: frequency matching and propensity score matching. Femoral neck, total hip and lumbar spine BMD were assessed annually and rate of loss was calculated and used as outcomes. Mixed-effects regression modeling strategy was used to examine the association between antihypertensive use and BMD loss. Results: Among 2365 eligible women, we identified new users of angiotensin-converting enzyme inhibitors (ACE), beta blocker, and thiazide diuretics (N= 98, 107, and 99, respectively) and frequency-matched nonusers (N=1001). After propensity score matched sets were created, 69 ACE, 88 beta blocker and 76 thiazide users were matched with equal numbers of nonusers. After adjustment for potential confounders, both methods show that thiazide diuretics have a protective effect on femoral neck, total hip and lumbar annualized BMD loss compared to nonusers. Neither ACE nor beta blocker has an association with BMD loss at any anatomic site. After matched using propensity scores, it shows that thiazide has a significantly protective effect on lumbar spine during late- and post- menopause, but not during pre- /peri-menopause. Conclusion: In this cohort of women across the menopausal transition, use of thiazide diuretics is associated with a decreased rate of bone loss at the lumbar spine, total hip and femoral neck and use of ACE or beta blocker is not associated with bone loss at any of the sites. Public Health Significance: The findings in this study provided reassurance for women who were using ACE or beta blocker to control blood pressure during the menopause transition, because neither of them has any negative effect on BMD loss during the transition. The results of this study also encourage clinicians to integrate the benefits of using thiazide diuretics, from the prospective of protecting the bone loss, into patients’ education, especially for women during late- or post-menopause if there are no other contraindications.


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Details

Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Zhao, Zhenping
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairBertolet, Marniebertoletm@edc.pitt.eduMHB12UNSPECIFIED
Committee MemberBrooks, Maria Mbrooks@edc.pitt.eduMBROOKSUNSPECIFIED
Committee MemberMatthews, Karen Amatthewska@upmc.eduXYOOUNSPECIFIED
Committee MemberRuppert, Kristineruppertk@pitt.eduRUPPERTKUNSPECIFIED
Date: 2014
Date Type: Publication
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Publisher: University of Pittsburgh
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: No
Date Deposited: 24 Apr 2015 18:18
Last Modified: 08 Feb 2021 11:55
URI: http://d-scholarship.pitt.edu/id/eprint/21217

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