title: Bone mineral density changes among women initiating blood pressure lowering drugs: a SWAN cohort study.
abstract: CONCLUSIONS
  We examined the effect of blood pressure lowering drugs on BMD using data from the Study of Women's Health Across the Nation. Thiazide users had a slower decline in BMD compared to nonusers, while decline among ACE inhibitor and beta blocker users were similar to rates in nonusers.
  
  
  BACKGROUND
  Several blood pressure lowering drugs may affect bone mineral density (BMD), leading to altered fracture risk. We examined the effect of blood pressure lowering drugs on BMD using data from the Study of Women's Health Across the Nation.
  
  
  METHODS
  We conducted a propensity score matched cohort study. Women were initiators of ACE inhibitors (ACEi), beta-blockers (BB), or thiazide diuretics (THZD). Their annualized BMD changes during the 14 years of observation were compared with nonusers.
  
  
  RESULTS
  Among the 2312 eligible women, we found 69 ACEi, 71 BB, and 74 THZD users who were matched by a propensity score with the same number of nonusers. THZD users had a slower annual percent decline in BMD compared to nonusers at the femoral neck (FN) (-0.28% vs -0.88%; p = 0.008) and the spine (-0.74% vs -1.0%; p = 0.34), albeit not statistically significant. Annual percent changes in BMD among ACEi and BB users were similar to rates in nonusers. In comparison with BB, THZD use was associated with a trend toward less annualized BMD loss at the spine (-0.35% vs -0.60%; p = 0.08) and a similar trend at the FN (-0.39% vs -0.64%; p = 0.08); in comparisons with ACEi, THZD was also associated with less loss at the FN (-0.48% vs -0.82%; p = 0.02), but not at the spine (-0.40% vs -0.56%; p = 0.23).
  
  
  CONCLUSIONS
  Neither ACEi nor BB was associated with improvements in BMD. THZD use was associated with less annualized loss of BMD compared with nonusers, as well as compared with ACEi and BB.
authors.affiliation: Division of Rheumatology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. dsolomon@partners.org.|Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, MA, USA. dsolomon@partners.org.
authors.forename: D H
authors.initials: DH
authors.lastname: Solomon
authors.affiliation: Department of Medicine and Division of Epidemiology & Community Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Ruppert
authors.affiliation: Department of Medicine and Division of Epidemiology & Community Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: Division of Rheumatology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Y J
authors.initials: YJ
authors.lastname: Lian
authors.affiliation: Division of Rheumatology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: I-H
authors.initials: IH
authors.lastname: Kuo
authors.affiliation: Department of Medicine, University of California - Los Angeles, Los Angeles, CA, USA.
authors.forename: G A
authors.initials: GA
authors.lastname: Greendale
authors.affiliation: Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Finkelstein
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology; D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology; D000959:Antihypertensive Agents / Q000494:pharmacology*; D015519:Bone Density / Q000187:drug effects*; D015331:Cohort Studies; D005260:Female; D005272:Femur Neck / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000503:physiopathology; D008875:Middle Aged; D010024:Osteoporosis / Q000503:physiopathology / Q000517:prevention & control*; D057216:Propensity Score; D012307:Risk Factors; D012959:Socioeconomic Factors; D049993:Sodium Chloride Symporter Inhibitors / Q000494:pharmacology
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D049993:Sodium Chloride Symporter Inhibitors
keywords: Cohort; Epidemiology; Hypertension; Osteoporosis