Effects of a beta-blocker on bone turnover in normal postmenopausal women: a randomized controlled trial.
BACKGROUND
The central nervous system has been demonstrated to regulate bone mass in mice, possibly via the beta2-adrenoreceptors on osteoblasts. beta-blockers increase bone mass in mice, and some observational studies have suggested a beneficial effect of these drugs on bone in humans


METHODS
We studied 41 normal postmenopausal women.


METHODS
We conducted a randomized, placebo- controlled trial, comparing the effects on bone markers of propranolol 160 mg/d and placebo over 3 months.


RESULTS
Serum osteocalcin declined by almost 20% in the first 2 wk of propranolol treatment, and this effect increased over time (P < 0.0001). Other osteoblast markers, procollagen type-I N-terminal propeptide and total alkaline phosphatase activity, were not significantly changed by propranolol. Urine free deoxypyridinoline declined by approximately 10% between 0 and 6 wk (P = 0.019) in the beta-blocker group and was stable thereafter. Serum C-terminal telopeptide of type I collagen also showed a small decrease, but this was not significantly different between groups. Serum albumin concentrations decreased by more than 2 g/liter in the first 2 wk of propranolol treatment, remaining stable subsequently (P = 0.007). Serum creatinine tended to increase in the propranolol group (P = 0.06), as did weight. Bone densities in the lumbar spine and total proximal femur did not change significantly in either group.


CONCLUSIONS
The present study provides no evidence that beta-blocker drugs stimulate bone formation; if anything, propranolol reduces osteoblast activity. It also influences renal function and fluid balance, effects that might indirectly affect bone metabolism. Current evidence does not justify the use of beta-blockers for treatment of osteoporosis.
Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand. i.reid@auckland.ac.nz
Ian R
IR
Reid
Jenny
J
Lucas
Diana
D
Wattie
Anne
A
Horne
Mark
M
Bolland
Gregory D
GD
Gamble
James S
JS
Davidson
Andrew B
AB
Grey
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D000368:Aged; D015415:Biomarkers / Q000097:blood / Q000652:urine; D015519:Bone Density / Q000187:drug effects; D016723:Bone Remodeling / Q000187:drug effects*; D005260:Female; D005269:Femur / Q000378:metabolism; D006801:Humans; D008159:Lumbar Vertebrae / Q000378:metabolism; D008875:Middle Aged; D017698:Postmenopause / Q000378:metabolism; D011433:Propranolol / Q000494:pharmacology*; D012016:Reference Values
D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D011433:Propranolol