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The impact of Renin-Angiotensin System Inhibitors on bone fracture risk: a nationwide nested case-control study

Kwang Min Kim1, Eun Jung Hwang2, Sangjin Lee3

  • 1Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.

BMC Musculoskeletal Disorders
|January 3, 2024
PubMed
Abstract

Insights

Renin-angiotensin system inhibitors (RASi) significantly reduce fracture risk in elderly patients. Specifically, angiotensin receptor blockers (ARBs) showed a protective effect against fractures.

Area of Science:

  • Gerontology
  • Pharmacology
  • Orthopedics

Background:

  • Localized renin-angiotensin system (RAS) activation in bone contributes to osteoclastic resorption and osteoporosis.
  • Elderly hypertensive patients at risk of fractures may benefit from RAS inhibitors (RASi).

Purpose of the Study:

  • To investigate the association between RASi use and the incidence of newly developed fractures in a large cohort.
  • To explore the specific effects of different RASi classes (ACEi, ARBs) on fracture risk.

Main Methods:

  • Nested case-control study design.
  • 1,049 cases (newly diagnosed fractures) and matched controls (1:1 propensity score matching).
  • Conditional logistic regression analysis to assess RASi exposure and fracture incidence.

Main Results:

  • Overall RASi use was associated with significantly lower odds of fracture incidence (OR, 0.73; 95% CI, 0.59-0.91).
  • Angiotensin receptor blocker (ARB)-only users had fewer fractures than never-users (OR, 0.65; 95% CI, 0.49-0.86).
  • Reduced fracture risk was observed in RASi users without cerebrovascular disease, with BMI > 23, and with statin exposure.

Conclusions:

  • RASi use is significantly associated with a reduced incidence of fractures in the elderly.
  • RASi may serve as a valuable preventive strategy for osteoporotic fractures in at-risk elderly populations.
Keywords:
Angiotensin II receptor blockersDefined daily dosesFractureNested case–control studyRenin-angiotensin system inhibitors

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