title: ACE inhibitors and the risk of fractures: a meta-analysis of observational studies.
abstract: A meta-analysis was conducted to evaluate the effect of treatment with angiotensin-converting enzyme inhibitors on the risk of fractures. All the included articleswere retrieved from MEDLINE, EMBASE and the Cochrane Database. Trial eligibility and methodological quality were assessed before data extraction. Relative risk (RR) with corresponding 95% confidence intervals (95% CI) were used to assess the effect. Six case-control studies with11,387,668 participants met the inclusion criteria and were included in the meta-analysis. A small but significant risk effect on fractures was shown in the overall analysis of angiotensin-converting enzyme inhibitor users compared with nonusers (Pooled RR 1.27; 95% CI 1.01-1.60), although a relatively high heterogeneity was found across studies. In the stratified analysis, therewas no statistically significant association in the subgroups of hip fracture (Pooled RR 1.14; 95% CI 0.73-1.76) and the study quality (Pooled RR 1.13; 95% CI 0.89-1.44), while the over 65-year-old angiotensin-converting enzyme inhibitor users showed a stronger risk effect on fractures (Pooled RR 2.06; 95% CI 1.53-3.17). Moreover, age was found to be contributed a large part of the high heterogeneity across the included studies. This study demonstrated that the use of angiotensin-converting enzyme inhibitors might have a small but significant risk effect on fractures, especially for the over 65-year-old users. These results should be interpreted with caution as the relatively high heterogeneity across studies. Additional multiple observational studies and high quality data from randomized controlled trials are needed to confirm these findings.
authors.affiliation: Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou, China.
authors.forename: Yan-Zhen
authors.initials: YZ
authors.lastname: Cheng
authors.affiliation: Department of the Second Clinical Medical College, Zhujiang Hospital of Southern Medical University, Guangzhou, China.
authors.forename: Zhen-Zi
authors.initials: ZZ
authors.lastname: Huang
authors.affiliation: Department of the Second Clinical Medical College, Zhujiang Hospital of Southern Medical University, Guangzhou, China.
authors.forename: Ze-Feng
authors.initials: ZF
authors.lastname: Shen
authors.affiliation: Department of the Second Clinical Medical College, Zhujiang Hospital of Southern Medical University, Guangzhou, China.
authors.forename: Hai-Yang
authors.initials: HY
authors.lastname: Wu
authors.affiliation: Department of the Second Clinical Medical College, Zhujiang Hospital of Southern Medical University, Guangzhou, China.
authors.forename: Jia-Xin
authors.initials: JX
authors.lastname: Peng
authors.affiliation: School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, N.T., Hong Kong SAR, China.
authors.forename: Mary Miu Yee
authors.initials: MM
authors.lastname: Waye
authors.affiliation: School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, N.T., Hong Kong SAR, China. strao@link.cuhk.edu.hk.
authors.forename: Shi-Tao
authors.initials: ST
authors.lastname: Rao
authors.affiliation: Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou, China. 836220379@qq.com.
authors.forename: Li
authors.initials: L
authors.lastname: Yang
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D058866:Osteoporotic Fractures / Q000139:chemically induced*; D012306:Risk
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: ACE inhibitors; Fractures; Meta-analysis; Observational studies