NEWS - Beta blockers reduce risk of fractures

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Beta blockers reduce risk of fractures

Sep 14, 2004 Nainggolan

Basel, Switzerland - A new case-control study has found that current use of

beta blockersalong with thiazide diureticsfor hypertension is associated

with a significantly reduced fracture risk [1]. Dr G Schlienger

(University of Basel, Switzerland) and colleagues report their findings in

the September 15, 2004 issue of the Journal of the American Medical

Association.

Animal studies have suggested that the beta-blocker propranolol increases

bone formation, they explain, but data are limited on any associated reduced

risk of fracture in humans.

So they looked at the link between beta-blocker use, with or without

thiazide diuretics, and bone-fracture risk in men and women aged 30 to 79

years, analyzing data from the UK General Practice Research Database (GPRD).

The study included 30 601 patients with a new fracture diagnosis between

1993 and 1999 and 120 819 controls.

Hand and foot fractures were the most common

The most frequent fractures were of the hand/lower arm (42%) and of the foot

(15.1%). Data were adjusted for: smoking; body mass index; number of

practice visits; and use of calcium-channel blockers, ACE inhibitors,

antipsychotics, antidepressants, statins, antiepileptics, benzodiazepines,

corticosteroids, and estrogens.

Patients who used only beta blockers (3 or more prescriptions) had a 23%

lower risk for fracture compared with those who did not use either beta

blockers or thiazide diuretics. Those who used thiazides only (3 or more

prescriptions) had a 20% lower risk, and patients taking both had a 29%

lower risk.

Short exposure (1 to 2 prescriptions) did not materially alter the fracture

risk, and the association in longer-term users of beta blockers (20

prescriptions or more) was weaker in women (OR 0.92) than in men (OR0.69).

The researchers note that previous randomized clinical trials have shown an

increase in bone-mineral density or a decrease in bone loss in patients

treated with thiazide diuretics, but the mechanisms by which these drugs

influence bone metabolism " are not fully elucidated. "

Beta blockers have been shown to increase bone mass secondary to an increase

in both bone formation rate and osteoblast numbers in rodent studies, they

say. And in humans, " there is substantial evidence that the nervous system

participates in the regulation of bone remodeling, " they note.

Additional studies required

Many elderly patients with hypertension are at risk of developing

osteoporosis, and they may potentially profit from positive effects of . . .

beta blockers and thiazide diuretics on fracture risk.

" Although additional observational studies and controlled trials are needed

to confirm these potentially important findings, many elderly patients with

hypertension are at risk of developing osteoporosis, and they may

potentially profit from positive effects of the relatively inexpensive beta

blockers and thiazide diuretics on fracture risk,² the authors say.

Schlienger told rheumawire: " Whether any randomized controlled trials will

be performed is unclear; but since this would be the real 'gold standard' to

show a beneficial effect of beta-blocker use and fracture risk, it would be

very helpful. "

" Eventually, older studies using beta blockers might be reanalyzed if

comprehensive information on potential adverse drug reactions (including

fractures) was also collected. Our group might perform some additional

analyses in this context but is otherwise not planning to do further work in

this area, " he concluded.