Elsevier

Bone

Volume 38, Issue 4, April 2006, Pages 584-588
Bone

Angiotensin converting enzyme inhibitor use is associated with higher bone mineral density in elderly Chinese

https://doi.org/10.1016/j.bone.2005.09.011Get rights and content

Abstract

Hypertension and osteoporosis are two major chronic diseases affecting the elderly. A cross-sectional study of 3887 Chinese men (n = 1958) and women (n = 1929) was used to explore the association between angiotensin converting enzyme inhibitor (ACEI) use and bone mineral density (BMD). The participants were aged 65 years and above, and were recruited using a combination of private solicitation and public advertising from community centers, housing estates, and the general community in Hong Kong. Demographic, medical, and lifestyle information was obtained from face to face interviews using standardized questionnaire, and physical examination measurements included anthropometry, tibial, and brachial systolic blood pressures, femoral neck, total hip, and lumbar spine BMD. In multiple regression analyses, after adjusting for age, weight, height, thiazide, beta-blocker, calcium channel blocker, statin, corticosteroid, and calcium supplement use, history of diabetes, heart disease, peripheral vascular disease, cigarette smoking, alcohol intake, and physical activity level, ACEI use was associated with higher femoral neck BMD (+0.015 g/cm2, P = 0.035) in women, and higher femoral neck (+0.015 g/cm2, P = 0.017), total hip (+0.016 g/cm2, P = 0.021), and lumbar spine (+0.043 g/cm2, P < 0.001) BMD in men. Thiazide use was associated with higher BMD at all three sites in general, although associations with BMD increase at the total hip (P = 0.07) and femoral neck (P = 0.09) were weak in men. Calcium channel blocker use was only significantly associated with BMD increase at the lumbar spine (P = 0.03) in women, and beta-blocker use did not have significant associations with BMD at any site. This study suggests that in addition to thiazide diuretics ACEI may have possible benefits in treating not only hypertension but also osteoporosis among older Chinese.

Introduction

The relationship between hypertension and osteoporosis has been receiving more attention lately, and various studies have examined the effects of antihypertensive drugs on BMD and fractures [1], [2], [3], [4]. The beneficial effects of thiazide diuretics on reducing bone loss and hip fractures have been documented since the 1980s [5], [6], [7], while several recent studies have focused on the relationship between beta-blocker use and BMD and fracture [4], [8], [9]. One of these studies also noted a decreased fracture risk among long-term users of angiotensin converting enzyme (ACE) inhibitors [4]. In a randomized study, ACEI treatment was effective in increasing BMD in a subgroup of women with ACE DD polymorphism, which is associated with increased serum angiotensin II activities [10]. Locally, in a study examining general risk factors for BMD among older Chinese men, a positive association between ACEI use and BMD was observed [11]. With the growing concerns of osteoporosis and hypertension as major health problems in Asia [12], [13], it is advantageous to have therapies that can address both of these illnesses. This large community-based study provides a systematic first look into the associations between antihypertensive treatments (ACEIs, thiazide diuretics, beta-blockers, and calcium channel blockers) and BMD among older Chinese. In particular, it adds valuable information to the current limited evidence relating ACEI use to BMD.

Section snippets

Subjects

Four thousand community-dwelling Chinese aged 65 years and above were recruited using a combination of private solicitation and public advertising from community centers, housing estates, and the general community in Hong Kong. Stratified sampling was employed to ensure that approximately one-third of the participants fall into each of the following age strata: 65–69, 70–74, and 75+ years old. Informed consent was obtained from all the subjects, and the study was approved by the Research Ethics

Results

The mean age of the cohort was 72.4 years (range: 65 to 92 years) and similar between men and women (Table 1). As expected, women had lower BMD compared to men at the lumbar spine (0.753 vs. 0.951 g/cm2), femoral neck (0.584 vs. 0.688 g/cm2), and total hip (0.710 vs. 0.865 g/cm2). Women were less frequently prescribed ACE inhibitors (8.3% vs. 14.1%, P < 0.001) but more frequently thiazide diuretics (6.0% vs. 3.7%, P = 0.001) compared to men. Beta-blocker (16.8% vs. 15.8%, P = 0.41) and calcium

Discussion

Little has been reported on the relationship between ACEI use and osteoporosis. Moexepril was not found to affect cortical or trabecular bone mass among hypertensive ovariectomized rats [18], but in a case-control study involving over 151,000 subjects, Schlienger observed that long-term users of ACE inhibitors had a decreased risk of fracture [4]. One study of 134 hypertensive patients randomized to either enalapril, quinapril, or quinapril plus hydrochlorothiazide found that quinapril

Acknowledgments

This work was partially supported by the Research Grants Council Earmarked Grant CUHK4101/02M and the National Institutes of Health R01 grant AR049439-01A1. The authors wish to thank all the participants for their dedicated contribution to the study.

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