title: Beta-blocker use is associated with fragility fractures in postmenopausal women with coronary heart disease.
abstract: 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.
authors.affiliation: 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
authors.forename: Manuel
authors.initials: M
authors.lastname: Sosa
authors.forename: Pedro
authors.initials: P
authors.lastname: Saavedra
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Gómez de Tejada
authors.forename: José
authors.initials: J
authors.lastname: Mosquera
authors.forename: Ramón
authors.initials: R
authors.lastname: Pérez-Cano
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Olmos
authors.forename: Manuel
authors.initials: M
authors.lastname: Muñoz-Torres
authors.forename: María José
authors.initials: MJ
authors.lastname: Amérigo
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Moro
authors.forename: Manuel
authors.initials: M
authors.lastname: Díaz-Curiel
authors.forename: Javier
authors.initials: J
authors.lastname: Alegre
authors.forename: Jorge
authors.initials: J
authors.lastname: Malouf
authors.forename: Javier
authors.initials: J
authors.lastname: Del Pino
authors.forename: Xavier
authors.initials: X
authors.lastname: Nogués
authors.forename: Antonio
authors.initials: A
authors.lastname: Torrijos
mesh_terms: 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
chemical_list: D000319:Adrenergic beta-Antagonists