Effects of antihypertensive drug treatments on fracture outcomes: a meta‐analysis of observational studies

Wiens, Matthew O.; Etminan, Mahyar; Gill, SS; Takkouche, Bahi

doi:10.1111/j.1365-2796.2006.01695.x

Cited by 162 publications

(105 citation statements)

References 71 publications

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“…Loop diuretics, used to treat HF, may also play a role in predisposing to osteoporosis by increasing renal calcium wasting (18). In our analysis, however, loop diuretics were not shown to be significantly associated with vertebral fractures and one could argue that other drugs commonly used in patients with HF, such as thiazide diuretics, betablockers, anti-aldosterone drugs, and angiotensinconverting enzyme inhibitors may have attenuated the negative skeletal effects of loop diuretics (41,42,43). The state of mild inflammation underlying heart disease may be considered in the pathogenesis of osteoporosis and fragility fractures occurring in patients with HF (44,45).…”

Section: All Vertebral Fracturescontrasting

confidence: 52%

Prevalence of thoracic vertebral fractures in hospitalized elderly patients with heart failure

Mazziotti

Baracca

Doga

et al. 2012

European Journal of Endocrinology

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Objective: Heart failure (HF) has been associated with increased risk of fragility fractures. Indeed, most literature data on fractures were based on an historical and clinical approach focused on the identification of peripheral fractures, whereas the risk of vertebral fractures in this clinical setting is still unclear. Design: Cross-sectional study. Aim: To evaluate the prevalence and determinants of radiological thoracic vertebral fractures in patients with HF. Methods: The study includes 1031 elderly hospitalized patients (491 females and 540 males; median age, 75 years; range, 65-90; 430 patients with HF) who were evaluated for the presence of thoracic vertebral fractures by quantitative morphometric analysis, using chest X-ray routinely performed in the diagnostic work-up of HF. Results: Vertebral fractures were found in 166 patients (16.1%), the prevalence being significantly higher in patients with HF as compared with those without HF, both in females (30.9 vs 15.8%; P!0.001) and in males (16.4 vs 7.4%; PZ0.001). The association between HF and vertebral fractures remained statistically significant (odds ratio, 2.14; 95% CI, 1.25-3.66; PZ0.01) even after adjustment for age, sex, loop diuretic therapy, anticoagulant therapy, proton pump therapy, coexistent chronic obstructive pulmonary disease, diabetes mellitus, renal insufficiency, and chronic liver diseases. In patients with HF, vertebral fractures were positively correlated with female sex, duration of HF, ischemic heart disease, cigarette smoking, and treatment with anti-osteoporotic drugs, and inversely correlated with left ventricular ejection fraction. Conclusions: Hospitalized patients suffering from HF are at higher risk of vertebral fractures than patients without HF in the same clinical context.

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Section: All Vertebral Fracturescontrasting

confidence: 52%

Prevalence of thoracic vertebral fractures in hospitalized elderly patients with heart failure

Mazziotti

Baracca

Doga

et al. 2012

European Journal of Endocrinology

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“…In a meta-analysis of 54 nonrandomized studies conducted in patients without HF, ␤-blockers and thiazide diuretics were associated with reduced fracture frequency, and loop diuretics were associated with an increased fracture frequency. 12 In a large case-control study, angiotensin-converting enzyme inhibitors were associated with a significant reduction in fracture risk, whereas angiotensin receptor blockers and potassium-sparing diuretics showed no effect on fractures. 13 To the best of our knowledge, no study has directly examined the link between HF and subsequent orthopedic fracture.…”

Section: Clinical Perspective P 1952mentioning

confidence: 99%

Heart Failure Is a Risk Factor for Orthopedic Fracture

et al. 2008

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Background— Heart failure (HF) is associated with factors that may contribute to accelerated bone loss and subsequent fractures. Whether it leads to an increased fracture risk is unknown. Methods and Results— A population-based cohort of consecutive patients ≥65 years of age with cardiovascular disease presenting to all emergency rooms between 1998 and 2001 in Alberta, Canada (n=16294 patients), was used. The 2041 patients with a new diagnosis of HF were compared with a control group of 14 253 patients with non-HF cardiovascular diagnoses. The primary outcome was any orthopedic fracture requiring hospital admission in the year after the emergency room visit. Patients with HF had a median age of 78 years (interquartile range, 72 to 84 years), and 51.9% were female; control subjects had a median age of 73 years (interquartile range, 68 to 79 years), and 53.2% were female. In the first year after the emergency room visit, 4.6% of the HF cohort (n=93) and 1.0% of patients without HF (n=147) sustained an orthopedic fracture ( P <0.001). Hip fractures occurred in 26 HF patients (1.3%) and 18 patients (0.1%) without HF ( P <0.001). After multivariable adjustment, HF was independently associated with a greater risk of any orthopedic fracture (adjusted odds ratio, 4.0; 95% CI, 2.9 to 5.3) or hip fracture (adjusted odds ratio, 6.3; 95% CI, 3.4 to 11.8). Conclusions— HF is associated with an increased risk of subsequent orthopedic fracture, particularly hip fracture. This suggests that screening for and treatment of osteoporosis to reduce fracture risk need to be considered in those with HF.

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“…68 Accordingly, a relevant metaanalysis of seven observational studies associated the use of BB with a significant reduction of any type of fracture [Relative Risk 0.86, 95% Confidence Interval (CI) 0.70-0.98]. 69 In a case-control study using as a reference population 944 postmenopausal women referred for BMD measurement, BB users had higher BMD and a borderline significantly lower risk for fractures at all sites (odds ratio 0.56; 95% CI: 0.30-0.99). 70 In a prospective, population-based study of 1,793 subjects with mean follow-up of around 11 years, the association between the use of BB and incidence of any fracture was significant after adjustment for a variety of potential effect modifiers [Hazard ratio 0.60; 95% CI = 0.37-0.96).…”

Section: Evidence For Potential Usefulness Of Bb As Anabolic Therapy mentioning

confidence: 99%

Targeting the osteoblast: approved and experimental anabolic agents for the treatment of osteoporosis

Toulis¹,

Anastasilakis²,

Polyzos³

et al. 2011

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targeting osteoblast may be the means of effectively improving both bone quality and mass, thus offering an intriguing alternative in the treatment of osteoporosis. Aside from injectable parathyroid hormone (PtH) and its novel preparations, PtH-related peptide (PtHrP), calcilytics, beta-adrenergic receptors, enhancement of Wnt signaling (mainly via sclerostin and Dickkopf-1 neutralization), regulation of low-density lipoprotein receptor-related protein (LPr) 5/osteoblast axis, activin, IGF-1, and bone morphogenic proteins (bMPs) are reviewed for their basic rationale and evidence of bone anabolic potential. sclerostin neutralizing antibody, teriparatide transdermal patch, and PtHrP (1-36) are currently at an advanced stage of research. safety and tissue specificity are the prerequisites in the development of a novel treatment, especially when addressing a chronic condition such as osteoporosis.

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Effects of antihypertensive drug treatments on fracture outcomes: a meta‐analysis of observational studies

Cited by 162 publications

References 71 publications

Prevalence of thoracic vertebral fractures in hospitalized elderly patients with heart failure

Prevalence of thoracic vertebral fractures in hospitalized elderly patients with heart failure

Heart Failure Is a Risk Factor for Orthopedic Fracture

Targeting the osteoblast: approved and experimental anabolic agents for the treatment of osteoporosis

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