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Angiotensin Receptor Blocker is Associated with a Lower Fracture Risk: An Updated Systematic Review and Meta-Analysis
Jing Wu1,2,3,4,5, Mei Wang1,2,3,4, Man Guo1,2,3,4
1Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China.
Insights
Angiotensin receptor blockers (ARBs) may reduce fracture risk, unlike angiotensin-converting enzyme inhibitors (ACEIs). ARBs show particular benefit for males and Europeans in preventing fractures, especially hip fractures.
Area of Science:
- Cardiology
- Pharmacology
- Gerontology
Background:
- Hypertension is a common condition often associated with osteoporosis.
- The impact of antihypertensive medications, specifically ACEIs and ARBs, on fracture risk is not fully understood.
- Existing research presents conflicting findings regarding the relationship between ACEI/ARB use and fracture incidence.
Purpose of the Study:
- To conduct a meta-analysis to clarify the association between the use of ACEIs and ARBs and the risk of fractures.
- To provide updated evidence on the potential benefits or risks of these drug classes concerning bone health.
Main Methods:
- A systematic literature search was performed across major databases including PubMed, EMBASE, Cochrane Library, and Web of Science.
- Prospective studies investigating the relationship between ACEI/ARB use and fracture risk were included.
- Data from nine prospective studies encompassing over 3.6 million participants were analyzed.
Main Results:
- Angiotensin-converting enzyme inhibitor (ACEI) use was not associated with a significant reduction in composite or hip fracture risk.
- Angiotensin receptor blocker (ARB) use was linked to a decreased risk of both composite fractures (RR=0.82) and hip fractures (RR=0.85).
- Subgroup analyses indicated that males and individuals of European descent may experience a greater protective effect from ARBs against fractures.
Conclusions:
- ACEI therapy does not appear to lower the risk of osteoporosis-related fractures.
- ARB therapy demonstrates a protective effect against total and hip fractures, particularly in male and European populations.
- For hypertensive patients with increased fracture risk, the potential benefits of ARBs over ACEIs should be considered in treatment decisions.
Background:
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are widely used in the treatment of hypertension. Hypertension is often accompanied by osteoporosis. However, the relationship between ACEI/ARB and fractures remains controversial. The purpose of this meta-analysis was to update the potential relationship between ACEI/ARB and fractures.
Methods:
This meta-analysis was identified through PubMed, EMBASE, Cochrane Library, and Web of Science. Related studies about ACEI/ARB with the risk of fracture were published from inception to June 2022.
Results:
Nine qualified prospective designed studies, involving 3,649,785 subjects, were included in this analysis. Overall, the RRs of ACEI compared with the nonusers were 0.98 (95% CI: 0.88, 1.10; P < 0.001) for composite fractures and 0.96 (95% CI: 0.87, 1.05; P=0.048) for hip fractures; the RRs of ARB compared to the nonusers were 0.82 (95% CI: 0.73, 0.91; P < 0.001) for composite fractures and 0.85 (95% CI: 0.74, 0.97; P=0.028) for hip fractures. Furthermore, in the subgroup analysis, male may benefit from ARB (RR = 0.65, 95% CI: 0.49, 0.89, P=0.028), and the European may also benefit from ARB (RR = 0.86, 95% CI: 0.80, 0.93, P=0.015).
Conclusions:
ACEI usage will not decrease the risk of osteoporosis fracture. On the contrary, ARB usage can decrease the risk of total fracture and hip fracture, especially for males and Europeans. Compared with ACEI, for patients at higher risk of fracture in cardiovascular diseases such as hypertension, the protective effect of ARB should be considered.
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