Exploring the Interplay Between Hypertension and Osteoporosis: A Narrative Review

Hypertension and osteoporosis are highly prevalent chronic conditions that have significant implications for global health, especially in aging populations. While these conditions have traditionally been viewed as separate, emerging research suggests a strong pathophysiological link between the two. Understanding these shared mechanisms may help improve screening and guide integrated management strategies. This narrative review was conducted between January 2024 and July 2025 using PubMed, ScienceDirect, and Google Scholar. The search strategy used the Boolean string: ("hypertension" OR "high blood pressure") AND ("osteoporosis" OR "bone loss"), supplemented with pharmacologic terms ("ACE inhibitors," "angiotensin receptor blockers," "thiazide diuretics," "beta-blockers", "SERMS", "Bisphosphonates", "Denosumab", "romosozumab", and "teriparatide"). Filters included English language, peer-reviewed human and animal studies when mechanically relevant. A total of 336 articles were retrieved, 143 titles and abstracts were screened, and 61 articles were selected. Data were synthesized qualitatively and organized thematically. Evidence demonstrates that oxidative stress and the renin-angiotensin-aldosterone system (RAAS) activation serve as strong mechanisms linking osteoporosis and hypertension. These pathways promote endothelial dysfunction, osteoclastogenesis, and impaired osteoblast activity. Hormonal disturbances such as estrogen deficiency can further exacerbate both vascular and skeletal deterioration. Several antihypertensive medications, including thiazide diuretics, angiotensin-converting enzyme inhibitors (ACEis), and angiotensin II receptor blockers (ARBs), show bone protective effects; however, most osteoporosis medications exhibit neutral or mixed influence on the cardiovascular system. Hypertension and osteoporosis share connected biological pathways that contribute to both vascular dysfunction and bone loss. Recognizing this connection can encourage therapeutic approaches and address cardiovascular and skeletal health. Further research is needed to define appropriate dual interventions.