Open Access Research article

Laxative use and incident falls, fractures and change in bone mineral density in postmenopausal women: results from the Women’s Health Initiative

Bernhard Haring1*, Mary Pettinger2, Jennifer W Bea3, Jean Wactawski-Wende4, Ryan M Carnahan5, Judith K Ockene6, Moritz Wyler von Ballmoos7, Robert B Wallace5 and Sylvia Wassertheil-Smoller8

Author Affiliations

1 Department of Internal Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Oberdürrbacher Strasse 6, Würzburg, 97080, Germany

2 Fred Hutchinson Cancer Research Center, Seattle, Washington, USA

3 Arizona Cancer Center, University of Arizona, Tucson, Arizona, USA

4 Department of Social and Preventive Medicine, University at Buffalo, SUNY School of Public Health and Health Professions, Buffalo, NY, USA

5 Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA

6 Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA

7 Department of Surgery & Division of Cardiothoracic Surgery, Froedtert Memorial Hospital & Medical College of Wisconsin, Milwaukee, WI, USA

8 Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA

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BMC Geriatrics 2013, 13:38  doi:10.1186/1471-2318-13-38

Published: 1 May 2013

Abstract

Background

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 (≥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.

Keywords:
Laxative use; Falls; Fractures; Bone mineral density; Aging