Abstract
The increased sympathetic nervous activity causes bone loss, via an increase in osteoclastic bone resorption and a decrease in osteoblastic bone formation, suggesting an important regulating role for the SNS in bone metabolism. Such findings may indicate that pharmacological beta-blockade could be a target to increase bone mass and reduce the risk of fractures. This review summarized the impact of beta-blockers on bone mineral density, bone turnover markers and fracture risk.
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Anagnostis P, Karagiannis A, Kakafika AI, Tziomalos K, Athyros VG, Mikhailidis DP. Atherosclerosis and osteoporosis: age-dependent degenerative processes or related entities? Osteoporos Int. 2009;20:197–207.
Hernández JL, Olmos JM, Romaña G, Llorca J, Martínez J, Castillo J, de Juan J, Pérez-Pajares I, Ruiz S, González-Macías J. Influence of vitamin D status on the effect of statins on bone mineral density and bone turnover markers in postmenopausal women. J Clin Endocrinol Metab. 2014;99:3304–9.
Olmos JM, Hernández JL, Martínez J, Castillo J, Valero C, Pérez Pajares I, Nan D, González-Macías J. Bone turnover markers and bone mineral density in hypertensive postmenopausal women on treatment. Maturitas. 2010;65:396–402.
Togari A, Arai M, Kondo A. The role of the sympathetic nervous system in controlling bone metabolism. Expert Opin Ther Targets. 2005;9:931–40.
Takeda S, Elefteriou F, Levasseur R, Liu X, Zhao L, Parker KL, Armstrong D, Ducy P, Karsenty G. Leptin regulates bone formation via the sympathetic nervous system. Cell. 2002;111:305–17.
Baek K, Bloomfield SA. Blocking β-adrenergic signaling attenuates reductions in circulating leptin, cancellous bone mass, and marrow adiposity seen with dietary energy restriction. J Appl Physiol. 1985;2012(113):1792–801.
Bonnet N, Pierroz DD, Ferrari SL. Adrenergic control of bone remodeling and its implications for the treatment of osteoporosis. J Musculoskelet Neuronal Interact. 2008;8:94–104.
Togari A, Arai M. Pharmacological topics of bone metabolism: the physiological function of the sympathetic nervous system in modulating bone resorption. J Pharmacol Sci. 2008;106:542–6.
Pérez-Castrillón JL, De Luis DA, Duenas-Laita A. Are beta-blockers useful in the prevention of osteoporotic fractures? Eur Rev Med Pharmacol Sci. 2009;13:157–62.
Pasco JA, Henry MJ, Sanders KM, Kotowicz MA, Seeman E, Nicholson GC, Geelong Osteoporosis Study. Beta-adrenergic blockers reduce the risk of fracture partly by increasing bone mineral density: Geelong Osteoporosis Study. J Bone Miner Res. 2004;19:19–24.
Rejnmark L, Vestergaard P, Kassem M, Christoffersen BR, Kolthoff N, Brixen K, Mosekilde L. Fracture risk in perimenopausal women treated with beta-blockers. Calcif Tissue Int. 2004;75:365–72.
Reid IR, Gamble GD, Grey AB, Black DM, Ensrud KE, Browner WS, Bauer DC. Beta-blocker use, BMD, and fractures in the study of osteoporotic fractures. J Bone Miner Res. 2005;20:613–8.
Levasseur R, Dargent-Molina P, Sabatier JP, Marcelli C, Breart G. Beta-blocker use, bone mineral density, and fracture risk in older women: results from the Epidemiologie de L’Osteoporose Prospective Study. J Am Geriatr Soc. 2005;53:550–2.
Turker S, Karatosun V, Gunal I. Beta-blockers increase bone mineral density. Clin Orthop Relat Res. 2006;443:73–4.
Bonnet N, Gadois C, McCloskey E, Lemineur G, Lespessailles E, Courteix D, Benhamou CL. Protective effect of beta blockers in postmenopausal women: influence on fractures, bone density, micro and macroarchitecture. Bone. 2007;40:1209–16.
Pérez-Castrillón JL, Vega G, Abad L, Sanz A, Mendo M, Porrero MG, Dueñas A. Effect of beta-blockers on bone mass and biomechanical parameters of the femoral neck in males with acute myocardial infarction. Joint Bone Spine. 2007;74:259–62.
Yang S, Nguyen ND, Center JR, Eisman JA, Nguyen TV. Association between beta-blocker use and fracture risk: the Dubbo Osteoporosis Epidemiology Study. Bone. 2011;48:451–5.
Sosa M, Saavedra P, Gómez de Tejada MJ, Mosquera J, Pérez-Cano R, Olmos JM, Muñoz-Torres M, Amérigo MJ, Moro MJ, Díaz-Curiel M, Alegre J, Malouf J, Del Pino J, Nogués X, Torrijos A, GIUMO Cooperative Group. Beta-blocker use is associated with fragility fractures in postmenopausal women with coronary heart disease. Aging Clin Exp Res. 2011;23:112–7.
Bleicher K, Cumming RG, Naganathan V, Seibel MJ, Blyth FM, Le Couteur DG, Handelsman DJ, Creasey HM, Waite LM. Predictors of the rate of BMD loss in older men: findings from the CHAMP study. Osteoporos Int. 2013;24:1951–63.
Ağaçayak KS, Güven S, Koparal M, Güneş N, Atalay Y, Atılgan S. Long-term effects of antihypertensive medications on bone mineral density in men older than 55 years. Clin Interv Aging. 2014;9:509–13.
Reid IR, Lucas J, Wattie D, Horne A, Bolland M, Gamble GD, Davidson JS, Grey AB. Effects of a beta-blocker on bone turnover in normal postmenopausal women: a randomized controlled trial. J Clin Endocrinol Metab. 2005;90:5212–6.
Rejnmark L, Vestergaard P, Mosekilde L. Treatment with beta-blockers, ACE inhibitors, and calcium-channel blockers is associated with a reduced fracture risk: a nationwide case–control study. J Hypertens. 2006;24:581–9.
Schlienger RG, Kraenzlin ME, Jick SS, Meier CR. Use of beta-blockers and risk of fractures. JAMA. 2004;292:1326–32.
Wiens M, Etminan M, Gill SS, Takkouche B. Effects of antihypertensive drug treatments on fracture outcomes: a meta-analysis of observational studies. J Intern Med. 2006;260:350–62.
de Vries F, Souverein PC, Cooper C, Leufkens HG, van Staa TP. Use of beta-blockers and the risk of hip/femur fracture in the United Kingdom and The Netherlands. Calcif Tissue Int. 2007;80:69–75.
de Vries F, Pouwels S, Bracke M, Leufkens HG, Cooper C, Lammers JW, van Staa TP. Use of beta-2 agonists and risk of hip/femur fracture: a population-based case–control study. Pharmacoepidemiol Drug Saf. 2007;16:612–9.
Yang S, Nguyen ND, Eisman JA, Nguyen TV. Association between beta-blockers and fracture risk: a Bayesian meta-analysis. Bone. 2012;51:969–74.
Toulis KA, Hemming K, Stergianos S, Nirantharakumar K, Bilezikian JP. b-Adrenergic receptor antagonists and fracture risk: a meta-analysis of selectivity, gender, and site-specific effects. Osteoporos Int. 2014;25:121–9.
van Staa TP, Dennison EM, Leufkens HG, Cooper C. Epidemiology of fractures in England and Wales. Bone. 2001;29:517–22.
Butt DA, Mamdani M, Austin PC, Tu K, Gomes T, Glazier RH. The risk of hip fracture after initiating antihypertensive drugs in the elderly. Arch Intern Med. 2012;172:1739–44.
Jensen J, Nielsen LH, Lyhne N, Hallas J, Brosen K. Drugs and femoral neck fracture: a case control study. J Intern Med. 1991;229:29–33.
Thorell K, Ranstad K, Midlöv P, Borgquist L, Halling A. Is use of fall risk-increasing drugs in an elderly population associated with an increased risk of hip fracture, after adjustment for multimorbidity level: a cohort study. BMC Geriatr. 2014;4(14):131.
Gage BF, Birman-Deych E, Radford MJ, Nilasena DS, Binder EF. Risk of osteoporotic fracture in elderly patients taking warfarin: results from the National Registry of Atrial Fibrillation 2. Arch Intern Med. 2006;166:241–46.
Meisinger C, Heier M, Lang O, Döring A. Beta-blocker use and risk of fractures in men and women from the general population: the MONICA/KORA Augsburg cohort study. Osteoporos Int. 2007;18:1189–95.
Solomon DH, Mogun H, Garneau K, Fischer MA. Risk of fractures in older adults using antihypertensive medications. J Bone Miner Res. 2011;26:1561–67.
Song HJ, Lee J, Kim YJ, Jung SY, Kim HJ, Choi NK, Park BJ. β1 selectivity of β-blockers and reduced risk of fractures in elderly hypertension patients. Bone. 2012;51:1008–15.
Shuto H, Imakyure O, Matsumoto J, Egawa T, Jiang Y, Hirakawa M, Kataoka Y, Yanagawa T. Medication use as a risk factor for inpatient falls in an acute care hospital: a case-crossover study. Br J Clin Pharmacol. 2010;69:535–42.
Järvinen TL, Sievänen H, Khan KM, Heinonen A, Kannus P. Shifting the focus in fracture prevention from osteoporosis to falls. BMJ. 2008;336:124–6.
Ham AC, Swart KM, Enneman AW, van Dijk SC, Oliai Araghi S, van Wijngaarden JP, van der Zwaluw NL, Brouwer-Brolsma EM, Dhonukshe-Rutten RA, van Schoor NM, van der Cammen TJ, Lips P, de Groot LC, Uitterlinden AG, Witkamp RF, Stricker BH, van der Velde N. Medication-related fall incidents in an older, ambulant population: the B-PROOF study. Drugs Aging. 2014;31:917–27.
Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM, Marra CA. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;23(169):1952–60.
Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc. 1999;47:40–50.
Zang G. Antihypertensive drugs and the risk of fall injuries: a systematic review and meta-analysis. J Int Med Res. 2013;41:1408–17.
Gribbin J, Hubbard R, Gladman JR, Smith C, Lewis S. Risk of falls associated with antihypertensive medication: population-based case–control study. Age Ageing. 2010;39:592–7.
Imai S, Matsusue Y. Neuronal regulation of bone metabolism and anabolism: calcitonin gene-related peptide-, substance P-, and tyrosine hydroxylase-containing nerves and the bone. Microsc Res Tech. 2002;58:61–9.
Minkowitz B, Boskey AL, Lane JM, Pearlman HS, Vigorita VJ. Effects of propranolol on bone metabolism in the rat. J Orthop Res. 1991;9:869–75.
Rodrigues WF, Madeira MF, da Silva TA, Clemente-Napimoga JT, Miguel CB, Dias-da-Silva VJ, Barbosa-Neto O, Lopes AH, Napimoga MH. Low dose of propranolol down-modulates bone resorption by inhibiting inflammation and osteoclast differentiation. Br J Pharmacol. 2012;165:2140–51.
Zhang X, Lv X, Zhang Y, Jiao X, Chen B. Propranolol prevents osteoporosis and up-regulates leptin in ovariectomized rats. Iran J Pharm Res. 2013;12:557–62.
Sandhu HS, Herskovits MS, Singh IJ. Effect of surgical sympathectomy on bone remodeling at rat incisor and molar root sockets. Anat Rec. 1987;219:32–8.
Cherruau M, Facchinetti P, Baroukh B, Saffar JL. Chemical sympathectomy impairs bone resorption in rats: a role for the sympathetic system on bone metabolism. Bone. 1999;25:545–51.
Pasco JA, Henry MJ, Nicholson GC, Schneider HG, Kotowicz MA. Beta-blockers reduce bone resorption marker in early postmenopausal women. Ann Hum Biol. 2005;32:738–45.
Lind L, Hänni A, Hvarfner A, Pollare T, Ljunghall S, Lithell H. Influences of different antihypertensive treatments on indices of systemic mineral metabolism. Am J Hypertens. 1994;7:302–7.
Veldhuis-Vlug AG, Tanck MW, Limonard EJ, Endert E, Heijboer AC, Lips P, Fliers E, Bisschop PH. The effects of beta-2 adrenergic agonist and antagonist on human bone metabolism: a randomized controlled trial. Bone. 2015;71:196–200.
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José L. Hernández and Carmen Valero declare that they have no any conflict of interest regarding this paper.
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Hernández, J.L., Valero, C. Effect of Beta-Blockers on Bone Mineral Density, Bone Turnover Markers and Fractures: A Clinical Review. Clinic Rev Bone Miner Metab 13, 185–193 (2015). https://doi.org/10.1007/s12018-015-9186-9
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DOI: https://doi.org/10.1007/s12018-015-9186-9