Hypertension, Antihypertensive Drugs, and Bone Mineral Density

Abstract

Hypertension and osteoporosis are often present concomitantly in older adults. This narrative review summarizes current knowledge on the effects of hypertension on bone mineral density (BMD) and the effects of major classes of antihypertensive medications on BMD. The relationship between hypertension and BMD has been studied extensively, but remains highly controversial. Commonly prescribed antihypertensive medications, such as thiazides, beta-adrenergic blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and calcium channel blockers, have mechanisms of action through which they could potentially affect bone metabolism and BMD. The evidence supports a small positive effect of thiazides in terms of increasing BMD or preventing decrease in BMD. Studies of the effect of betaadrenergic blockers and angiotensin-converting enzyme inhibitors on BMD have shown conflicting results. Very few studies have examined the effect of angiotensin II receptor blockers on BMD, and these studies are inconclusive. Studies of calcium channel blockers have found conflicting effects on BMD. Overall, definitive conclusions cannot be reached on the effect of antihypertensive drugs on BMD other than for thiazide diuretics.

Proteomic profiling of human bone from different anatomical sites – A pilot study

“…Since only five females with a mean age of 58 years were included, the findings cannot be generalized to males and to other age groups. Two patients used antihypertensive medication which is being discussed controversial regarding its influence on bone metabolism, that is, bone mineral density [45][46][47]. Interindividual and site-specific differences found in protein composition and regulation should be verified in larger cohorts, characterizing the oral and general health of these patients with detail.…”

Fracture Risk and Use of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers

“…This can then lead to increased activation of parathyroid tissue and a net loss of calcium from the bones [ 5 ]. Additionally, hypertension may result in a higher level of oxidative stress, which could also lead to poorer bone health [ 6 ]. Some medications used to lower blood pressure can result in orthostatic hypotension, particularly when first prescribed and this can increase the risk of falls which can lead to fracture [ 5 ].…”