Beta-blocker use is associated with fragility fractures in postmenopausal women with coronary heart disease.
OBJECTIVE
An association between cardiovascular disease and osteoporosis is described. A number of drugs often used by patients with coronary heart disease, such as thiazides, statins and beta-blockers, have shown controversial effects on bone. 1) To study the possible association between coronary heart disease (CHD) and bone mass density (BMD), quantitative ultrasound measurements (QUS) and the prevalence of fragility and vertebral fractures. 2) To study the possible influence of a number of drugs, statins, thiazides and beta-blockers, on BMD and fractures.


METHODS
Case-control study performed on 74 postmenopausal women who had recently suffered from CHD, and 111 age-matched controls. BMD was measured by Dual X-Ray Absorptiometry (DXA) at the lumbar spine and proximal femur. Quantitative Ultrasound (QUS) was also measured at the heel. Vertebral fractures were diagnosed by lateral, thoracic and lumbar X-rays. The occurrence of non-vertebral fractures was determined by examination of medical records.


RESULTS
Patients with CHD had higher values of BMI. They had a higher prevalence of arterial hypertension and hyperlipidemia, and consequently higher consumption of beta-blockers and statins, but not of thiazides, and had lower alcohol consumption. Patients with CHD had higher BMD values, measured by DXA at the proximal femur, than controls, but there were no differences in DXA values at the lumbar spine or QUS at the heel between the two groups. The prevalence of all fragility factures was slightly higher in patients with CHD, but not to a significant extent. The prevalence of vertebral fractures was similar in the two groups. In a logistic analysis to identify factors associated with all fractures, beta-blockers were positively associated with fragility fractures, and DXA at the femoral neck was inversely associated with fragility fractures.


CONCLUSIONS
Postmenopausal women with CHD have higher values of BMD at the proximal femur but, despite this, show a slight but non-significant increase in the prevalence of fragility fractures. Beta-blockers are independently associated with fragility fractures, but thiazides and statins are not.
Sosa
Manuel
M
University of Las Palmas de Gran Canaria, Investigation Group on Osteoporosis, Hospital University Insular, Spanish Society of Bone Investigation and Mineral Metabolism (SEIOMM), Working Group on Ultrasound and Bone Mineral Metabolism (GIUMO), Espronceda 2, 35005 Las Palmas de Gran Canaria, Canary Island, Spain. msosa@ono.com
Saavedra
Pedro
P
Gómez de Tejada
María Jesús
MJ
Mosquera
José
J
Pérez-Cano
Ramón
R
Olmos
José Manuel
JM
Muñoz-Torres
Manuel
M
Amérigo
María José
MJ
Moro
María Jesús
MJ
Díaz-Curiel
Manuel
M
Alegre
Javier
J
Malouf
Jorge
J
Del Pino
Javier
J
Nogués
Xavier
X
Torrijos
Antonio
A
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects*; D000368:Aged; D000375:Aging / Q000378:metabolism; D015992:Body Mass Index; D015519:Bone Density; D016022:Case-Control Studies; D003327:Coronary Disease / Q000150:complications* / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D005260:Female; D050723:Fractures, Bone / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D016015:Logistic Models; D008593:Menopause / Q000378:metabolism; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000209:etiology / Q000378:metabolism / Q000473:pathology; D012307:Risk Factors
D000319:Adrenergic beta-Antagonists