ASPIRIN AND NSAID USE IN OLDER WOMEN - EFFECT ON BONE-MINERAL DENSITYAND FRACTURE RISK

Prostaglandin inhibition by aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) may inhibit bone loss and preserve bone mineral density (BMD) in vitro and in animal models, The effect of these agents on BM D and fracture risk in postmenopausal women is unknown. We assessed th e risk factors for osteoporosis and the use of aspirin and NSAIDs in 7 786 white women over age 65. Axial BMD was measured at the same time, and fractures were prospectively documented over the subsequent 4 year s of follow-up, In age-adjusted analyses, daily use of aspirin or NSAI Ds was associated with a 2.3-5.8% increase in BMD of the hip and spine . The relationship persisted even after adjustment for weight, a varie ty of medications, self-reported arthritis, and for radiographic findi ngs of osteoarthritis, but the multiply adjusted increase in BMD was o nly 1.0-3.1%. Fracture risk was similar among daily users of aspirin a nd NSAIDs and nonusers, After adjustment for potential confounders, am ong daily aspirin users the relative risk of hip fracture was 1.1 (95% confidence interval [CI]: 0.7, 1.6), and among daily NSAID users the risk was 0.9 (CI: 0.6, 1.4). Considering all nonspine fractures togeth er, the risk among aspirin users was 1.0 (CI: 0.8, 1.2), and among NSA ID users the risk was also 1.0 (CI; 0.8, 1.2), Regular use of aspirin or NSAIDs may have a modest beneficial effect on BMD in postmenopausal women, This effect persists after adjustment for obesity and the pres ence of osteoarthritis. However, among women who take aspirin or NSAID s regularly, there is no clinically significant protective effect on t he subsequent risk of fractures.