The use of angiotensin receptor blocker (ARBs) in older men with hypertension was associated with a reduced incidence of non-vertebral fracture than angiotensin-converting enzyme (ACE) inhibitors or calcium channel blockers (CCBs), according to a study published in Age and Ageing

Angiotensin II is known to induce bone loss under certain conditions by acting on the renin angiotensin system (RAS). Medications that block the RAS may decrease bone loss and fracture incidence. Researchers from the Chinese University and the University of California compared the incidence of fracture in older hypertensive males with long-term use of ACE inhibitors or ARBs vs. CCBs and non-users. 

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A total of 5,994 men aged ≥65 years with bone mineral density measured at baseline in the Osteoporotic Fractures in Men Study (MrOS) were followed for an average 6.8 years. For the study (n=2,573), men with follow-up dual-energy X-ray absorptiometry bone mineral density data and who reported hypertension at any visit, or use of any antihypertensives at any visit were included.  

The data showed 619 men took ACE inhibitors whereas 182 took ARBs for ≥4 years. Long-term users of ACE inhibitors and ARBs demonstrated a significantly lower fracture incidence vs. non-users. Also, the hazard ratio (HR) of non-vertebral fractures was three times lower among men who took ARB vs. ACE inhibitors (HR 0.194, 95% CI: 0.079–0.474 vs. HR 0.620, 95% CI: 0.453–0.850; P=0.0168). A greater fracture risk reduction was seen with longer use of ARBs but not for ACE inhibitors.

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