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In developing our final model determining if statins were associated with a reduced risk for fractures, we included factors such as advanced age, female sex, and prednisone use because there was substantial evidence in the literature suggesting their association with fracture risk. For all other potential confounders, we first assessed whether the exposure of interest was associated with both statin use and the outcome in univariate models. Hydrochlorothiazide use was significantly associated with statin use but not with fracture after adjustment for duration of use. Therefore, we did not include hydrochlorothiazide use in our final model.

Geller and Adams suggest that we "erroneously stated" that the evidence supporting a beneficial association with thiazide use and fracture risk was limited. Although we agree that thiazide use has been shown to reduce urinary calcium excretion and in certain populations improve bone density, there is inconsistency in the epidemiological studies supporting . . . [Full Text of this Article]

AUTHOR INFORMATION
Richard E. Scranton, MD, MPH; Elizabeth Lawler, MPH; Melissa Young, MPH; J. Michael Gaziano, MD, MPH

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