ARB users exhibit a lower fracture incidence than ACE inhibitor users among older hypertensive men.
Angiotensin II, a major effector protein of the renin angiotensin system (RAS), induces bone loss under certain conditions. Drugs that block the RAS may therefore reduce bone loss and fracture incidence. The fracture incidence in older hypertensive men with long-term use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) were compared with the incidence in users of calcium channel blockers (CCBs) and non-users.



A total of 5,994 US men aged 65 years or older who had bone mineral density measured at baseline in the Osteoporotic Fractures in Men Study (MrOS) were followed for fracture incidence for an average of 6.8 years. Men with follow-up dual-energy X-ray absorptiometry bone mineral density data and who reported hypertension at any visit, or use of antihypertensive medications at any visit among those with non-missing mediation data were included in the study (N = 2,573).



Six hundred and nineteen men had taken ACE inhibitors, while 182 took ARBs for at least 4 years. Using Cox regression for the incidence of non-vertebral fractures, we found that long-term users of ACE inhibitors and ARBs each had a significantly lower fracture incidence than non-users. The hazard ratio of non-vertebral fractures was three times lower in ARB users than ACE inhibitor users (Hazard ratio (95% confidence interval): 0.194 (0.079–0.474) versus 0.620 (0.453–0.850), P = 0.0168). There was a trend of greater fracture risk reduction with longer duration of ARB use, but not for ACE inhibitor use.



In older hypertensive men, ARBs use was associated with lower incidence of non-vertebral fracture than ACE inhibitors or CCBs.
Department of Medicine & Therapeutics, the Chinese University of Hong Kong.
Timothy
T
Kwok
Jockey Club Centre for Osteoporosis Care and Control, the Chinese University of Hong Kong.
Jason
J
Leung
Division of Epidemiology, Department of Family Medicine and Public Health, School of Medicine, University of California.
Elizabeth
E
Barrett-Connor
D015502:Absorptiometry, Photon; D000367:Age Factors; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D015519:Bone Density / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control*; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D065840:Protective Factors; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers