title: Does the use of ACE inhibitors or angiotensin receptor blockers affect bone loss in older men?
abstract: In a prospective cohort study of 5,995 older American men (MrOS), users of angiotensin-converting enzyme (ACE) inhibitors had a small but significant increase in bone loss at the hip over 4 years after adjustment for confounders. Use of angiotensin II AT1 receptor blockers (ARB) was not significantly associated with bone loss.
  
  
  BACKGROUND
  Experimental evidence suggests that angiotensin II promotes bone loss by its effects on osteoblasts. It is therefore plausible that ACE inhibitor and ARB may reduce rates of bone loss. The objective of this study is to examine the independent effects of ACE inhibitor and ARB on bone loss in older men.
  
  
  METHODS
  Out of 5,995 American men (87.2%) aged ≥65 years, 5,229 were followed up for an average of 4.6 years in a prospective six-center cohort study-The Osteoporotic Fractures in Men Study (MrOS). Bone mineral densities (BMD) at total hip, femoral neck, and trochanter were measured by Hologic densitometer (QDR 4500) at baseline and year 4.
  
  
  RESULTS
  Out of 3,494 eligible subjects with complete data, 1,166 and 433 subjects reported use of ACE inhibitors and ARBs, respectively. When compared with nonusers, continuous use of ACE inhibitors was associated with a small (0.004 g/cm(2)) but significant increase in the average rate of BMD loss at total hip and trochanter over 4 years after adjustment for confounders. Use of ARB was not significantly associated with bone loss.
  
  
  CONCLUSIONS
  Use of ACE inhibitors but not ARB may marginally increase bone loss in older men.
authors.affiliation: Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, ROC. tkwok@cuhk.edu.hk
authors.forename: T
authors.initials: T
authors.lastname: Kwok
authors.forename: J
authors.initials: J
authors.lastname: Leung
authors.forename: Y F
authors.initials: YF
authors.lastname: Zhang
authors.forename: D
authors.initials: D
authors.lastname: Bauer
authors.forename: K E
authors.initials: KE
authors.lastname: Ensrud
authors.forename: E
authors.initials: E
authors.lastname: Barrett-Connor
authors.forename: P C
authors.initials: PC
authors.lastname: Leung
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D015519:Bone Density / Q000187:drug effects; D001862:Bone Resorption / Q000503:physiopathology*; D005269:Femur / Q000187:drug effects*; D005272:Femur Neck / Q000187:drug effects; D006621:Hip Joint / Q000187:drug effects*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors
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