Abstract
Summary
The present meta-analysis synthesized evidence from 10 articles encompassing 28 independent studies to verify the association between hypertension and osteoporotic fracture risk in women and men. Our results indicate that the risk of osteoporotic fracture among individuals with hypertension was higher than that among individuals without hypertension.
Introduction
Epidemiological studies have suggested that hypertension is related to osteoporotic fracture. However, discrepancies exist in the reported findings. In this study, a systematic review of relevant published articles was conducted to verify the association between hypertension and osteoporotic fracture risk in women and men.
Methods
PubMed (1953_October 5th, 2016) and Embase (1974_October 5th, 2016) were systematically searched for relevant articles. Odds ratios (ORs) and confidence intervals (CIs) were derived using random effect models. Categorical, subgroup, heterogeneity, publication bias, and meta-regression analyses were conducted.
Results
We analyzed 10 articles encompassing 28 independent studies, 1,430,431 participants, and 148,048 osteoporotic fracture cases. The risk of osteoporotic fracture among individuals with hypertension was higher (pooled OR = 1.33, 95% CI 1.25–1.40; I 2 = 72.3%, P < 0.001) than that among individuals without hypertension. The association between hypertension and fracture risk was slightly stronger in women (pooled OR = 1.52, 95% CI 1.30–1.79) than in men (pooled OR = 1.35, 95% CI 1.26–1.44). Studies conducted in Asia revealed results that were consistent with those of studies performed in Europe.
Conclusions
Hypertension is associated with osteoporotic fracture risk. However, the biological mechanisms underlying the effect of hypertension on osteoporotic fracture remain to be elucidated.
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References
Ferguson GT, Calverley PM, Anderson JA, Jenkins CR, Jones PW, Willits LR, Yates JC, Vestbo J, Celli B (2009) Prevalence and progression of osteoporosis in patients with COPD: results from the TOwards a Revolution in COPD Health study. Chest 136:1456–1465
Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res Off J Am Soc Bone Miner Res 15:721–739
Nguyen ND, Ahlborg HG, Center JR, Eisman JA, Nguyen TV (2007) Residual lifetime risk of fractures in women and men. J Bone Miner Res Off J Am Soc Bone Miner Res 22:781–788
Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 17:1726–1733
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J (2005) Global burden of hypertension: analysis of worldwide data. Lancet 365:217–223
Samelson EJ, Cupples LA, Broe KE, Hannan MT, O'Donnell CJ, Kiel DP (2007) Vascular calcification in middle age and long-term risk of hip fracture: the Framingham study. J Bone Miner Res 22:1449–1454
Popović MR, Tasić I (2009) Association between hypertension and osteoporosis in postmenopausal women. Acta Medica Medianae 48:8–13
Johnell O, Kanis JA, Oden A et al (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res Off J Am Soc Bone Miner Res 20:1185–1194
MacGregor GA, Cappuccio FP (1993) The kidney and essential hypertension: a link to osteoporosis? J Hypertens 11:781–785
Umemura S, Smyth DD, Nicar M, Rapp JP, Pettinger WA (1986) Altered calcium homeostasis in Dahl hypertensive rats: physiological and biochemical studies. J Hypertens 4:19–26
Izawa Y, Sagara K, Kadota T, Makita T (1985) Bone disorders in spontaneously hypertensive rat. Calcif Tissue Int 37:605–607
Cirillo M, Galletti F, Strazzullo P, Torielli L, Melloni MC (1989) On the pathogenetic mechanism of hypercalciuria in genetically hypertensive rats of the Milan strain. Am J Hypertens 2:741–746
Yang S, Chen A, Wu T (2015) Association of history of fracture with prehypertension and hypertension: a retrospective case-control study. BMC Musculoskelet Disord 16:86
Tsuda K, Nishio I, Masuyama Y (2001) Bone mineral density in women with essential hypertension. Am J Hypertens 14:704–707
Gerber Y, Melton LJ 3rd, McNallan SM, Jiang R, Weston SA, Roger VL (2013) Cardiovascular and noncardiovascular disease associations with hip fractures. Am J Med 126:169.e119–169.e126
Sennerby U, Farahmand B, Ahlbom A, Ljunghall S, Michaelsson K (2007) Cardiovascular diseases and future risk of hip fracture in women. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 18:1355–1362
Vestergaard P, Rejnmark L, Mosekilde L (2009) Hypertension is a risk factor for fractures. Calcif Tissue Int 84:103–111
Javed F, Khan SA, Ayers EW, Aziz EF, Akram MS, Nadkarni GN, Sabharwal MS, Ahmad Z, Benjo AM, Herzog E (2012) Association of hypertension and bone mineral density in an elderly African American female population. J Natl Med Assoc 104:172–178
Woo J, Kwok T, Leung J, Tang N (2009) Dietary intake, blood pressure and osteoporosis. J Hum Hypertens 23:451–455
Mussolino ME, Gillum RF (2006) Bone mineral density and hypertension prevalence in postmenopausal women: results from the Third National Health and Nutrition Examination Survey. Ann Epidemiol 16:395–399
Cota GF, de Sousa MR, Fereguetti TO, Rabello A (2013) Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: a systematic review with indirect comparison. PLoS Negl Trop Dis 7:e2195
Eimar H, Saltaji H, Ghorashi S, Isfeld D, MacLean JE, Gozal D, Graf D, Flores-Mir C (2017) Association between sleep apnea and low bone mass in adults: a systematic review and meta-analysis. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. doi:10.1007/s00198-017-3912-8
Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558
Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634
Sennerby U, Melhus H, Gedeborg R, Byberg L, Garmo H, Ahlbom A, Pedersen NL, Michaelsson K (2009) Cardiovascular diseases and risk of hip fracture. JAMA 302:1666–1673
Wada H, Hirano F, Kuroda T, Shiraki M (2012) Breast arterial calcification and hypertension associated with vertebral fracture. Geriatrics & gerontology international 12:330–335
Xu B, Han L, Liu H, Wang J, Bao XY, Xi HX, Zhao L, Yu GP (2013) Cardiovascular disease and hip fracture among older inpatients in Beijing, China. Biomed Res Int 2013:493696
Perez-Castrillon JL, Martin-Escudero JC, Alvarez Manzanares P, Cortes Sancho R, Iglesias Zamora S, Garcia Alonso M (2005) Hypertension as a risk factor for hip fracture. Am J Hypertens 18:146–147
El-Bikai R, Tahir MR, Tremblay J et al (2015) Association of age-dependent height and bone mineral density decline with increased arterial stiffness and rate of fractures in hypertensive individuals. J Hypertens 33:727–735 discussion 735
Park JS, Choi SB, Rhee Y, Chung JW, Choi EY, Kim DW (2015) Parathyroid hormone, calcium, and sodium bridging between osteoporosis and hypertension in postmenopausal Korean women. Calcif Tissue Int 96:417–429
Gadallah M, Massry SG, Bigazzi R, Horst RL, Eggena P, Campese VM (1991) Intestinal absorption of calcium and calcium metabolism in patients with essential hypertension and normal renal function. Am J Hypertens 4:404–409
Young EW, Morris CD, McCarron DA (1992) Urinary calcium excretion in essential hypertension. J Lab Clin Med 120:624–632
Strazzullo P, Nunziata V, Cirillo M, Giannattasio R, Ferrara LA, Mattioli PL, Mancini M (1983) Abnormalities of calcium metabolism in essential hypertension. Clin Sci 65:137–141
Hvarfner A, Bergstrom R, Morlin C, Wide L, Ljunghall S (1987) Relationships between calcium metabolic indices and blood pressure in patients with essential hypertension as compared with a healthy population. J Hypertens 5:451–456
Cappuccio FP, Meilahn E, Zmuda JM, Cauley JA (1999) High blood pressure and bone-mineral loss in elderly white women: a prospective study. Study of Osteoporotic Fractures Research Group. Lancet 354:971–975
McCarron DA, Pingree PA, Rubin RJ, Gaucher SM, Molitch M, Krutzik S (1980) Enhanced parathyroid function in essential hypertension: a homeostatic response to a urinary calcium leak. Hypertension 2:162–168
Perez-Castrillon JL, Justo I, Silva J et al (2003) Relationship between bone mineral density and angiotensin converting enzyme polymorphism in hypertensive postmenopausal women. Am J Hypertens 16:233–235
Perezcastrillon J (2003) Relationship between bone mineral density and angiotensin converting enzyme polymorphism in hypertensive postmenopausal women. Am J Hypertens 16:233–235
Guan XX, Zhou Y, Li JY (2011) Reciprocal roles of angiotensin II and angiotensin II receptors blockade (ARB) in regulating Cbfa1/RANKL via cAMP signaling pathway: possible mechanism for hypertension-related osteoporosis and antagonistic effect of ARB on hypertension-related osteoporosis. Int J Mol Sci 12:4206–4213
Browner WS, Seeley DG, Vogt TM, Cummings SR (1991) Non-trauma mortality in elderly women with low bone mineral density. Study of Osteoporotic Fractures Research Group. Lancet 338:355–358
Lehrer S, Rabin J, Kalir T, Schachter BS (1993) Estrogen receptor variant and hypertension in women. Hypertension 21:439–441
Parhami F, Basseri B, Hwang J, Tintut Y, Demer LL (2002) High-density lipoprotein regulates calcification of vascular cells. Circ Res 91:570–576
Yesil Y, Ulger Z, Halil M, Halacli B, Yavuz BB, Yesil NK, Kuyumcu ME, Cankurtaran M, Ariogul S (2012) Coexistence of osteoporosis (OP) and coronary artery disease (CAD) in the elderly: it is not just a by chance event. Arch Gerontol Geriatr 54:473–476
Resnick LM, Laragh JH, Sealey JE, Alderman MH (1983) Divalent cations in essential hypertension. Relations between serum ionized calcium, magnesium, and plasma renin activity. N Engl J Med 309:888–891
Bergland A, Jarnlo GB, Laake K (2003) Predictors of falls in the elderly by location. Aging Clin Exp Res 15:43–50
Elffors I, Allander E, Kanis JA et al (1994) The variable incidence of hip fracture in southern Europe: the MEDOS study. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 4:253–263
Wang Q, Huang Q, Zeng Y, Liang JJ, Liu SY, Gu X, Liu JA (2016) Parity and osteoporotic fracture risk in postmenopausal women: a dose-response meta-analysis of prospective studies. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 27:319–330
Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Ogelsby AK (2002) International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res Off J Am Soc Bone Miner Res 17:1237–1244
Jankowska EA, Susanne C, Rogucka E, Medras M (2002) The inverse relationship between bone status and blood pressure among Polish men. Ann Hum Biol 29:63–73
Metz JA, Morris CD, Roberts LA, McClung MR, McCarron DA (1999) Blood pressure and calcium intake are related to bone density in adult males. Br J Nutr 81:383–388
Larijani B, Bekheirnia MR, Soltani A, Khalili-Far A, Adibi H, Jalili RB (2004) Bone mineral density is related to blood pressure in men. American journal of human biology: the official journal of the Human Biology Council 16:168–171
Donaldson LJ, Cook A, Thomson RG (1990) Incidence of fractures in a geographically defined population. J Epidemiol Community Health 44:241–245
Li D, Lv J, Liu F, Liu P, Yang X, Feng Y, Chen G, Hao M (2015) Hypertension burden and control in mainland China: analysis of nationwide data 2003–2012. Int J Cardiol 184:637–644
Lim SS, Vos T, Flaxman AD et al (2012) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2224–2260
Yang G, Wang Y, Zeng Y et al (2013) Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 381:1987–2015
Acknowledgements
The work was funded by the National Natural Science Foundation of China (Grant No. 81573235), Health and Family Commission of Wuhan Municipality (Grant No. WG15D20), and Wuhan Jiang’an District Science and Technology Bureau (Grant No. 2014111904).
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Li, C., Zeng, Y., Tao, L. et al. Meta-analysis of hypertension and osteoporotic fracture risk in women and men. Osteoporos Int 28, 2309–2318 (2017). https://doi.org/10.1007/s00198-017-4050-z
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DOI: https://doi.org/10.1007/s00198-017-4050-z