Beta-blocker use is associated with fragility fractures in postmenopausal women with coronary heart disease
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Manuel Sosa1, Pedro Saavedra, María Jesús Gómez de Tejada
1University 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
Insights
Postmenopausal women with coronary heart disease (CHD) have higher bone density but a slightly increased risk of fragility fractures. Beta-blocker use is linked to these fractures, while thiazides and statins are not.
Area of Science:
- Cardiovascular Disease Research
- Bone Metabolism and Osteoporosis
- Pharmacological Effects on Bone Health
Background:
- An association exists between cardiovascular disease and osteoporosis.
- Common cardiovascular drugs like thiazides, statins, and beta-blockers have shown controversial effects on bone health.
Purpose of the Study:
- To investigate the association between coronary heart disease (CHD) and bone mass density (BMD), quantitative ultrasound (QUS) measurements, and fracture prevalence.
- To examine the influence of statins, thiazides, and beta-blockers on BMD and fracture risk in postmenopausal women.
Main Methods:
- A case-control study involving 74 postmenopausal women with recent CHD and 111 age-matched controls.
- Bone mineral density (BMD) measured using Dual X-ray Absorptiometry (DXA) at the lumbar spine and proximal femur.
- Quantitative Ultrasound (QUS) of the heel, and X-rays for vertebral fractures; medical records reviewed for non-vertebral fractures.
Main Results:
- Patients with CHD exhibited higher Body Mass Index (BMI), arterial hypertension, hyperlipidemia, and greater use of beta-blockers and statins.
- Higher BMD at the proximal femur was observed in CHD patients compared to controls; no significant differences in lumbar spine BMD or heel QUS.
- A slightly higher prevalence of fragility fractures in CHD patients was not statistically significant; vertebral fracture prevalence was similar between groups.
Conclusions:
- Postmenopausal women with CHD demonstrate higher proximal femur BMD but a non-significant increase in fragility fracture prevalence.
- Beta-blockers were independently associated with fragility fractures.
- Thiazides and statins showed no significant association with fragility fractures in this cohort.
Background And Aims:
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.
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