Elevated blood pressure, antihypertensive medications and bone health in the population: revisiting old hypotheses and exploring future research directions

Blood pressure and bone metabolism appear to share commonalities in their physiologic regulation. Specific antihypertensive drug classes may also influence bone mineral density. However, current evidence from existing observational studies and randomised trials is insufficient to establish causal associations for blood pressure and use of blood pressure-lowering drugs with bone health outcomes, particularly with the risks of osteoporosis and fractures. The availability and access to relevant large-scale biomedical data sources as well as developments in study designs and analytical approaches provide opportunities to examine the nature of the association between blood pressure and bone health more reliably and in greater detail than has ever been possible. It is unlikely that a single source of data or study design can provide a definitive answer. However, with appropriate considerations of the strengths and limitations of the different data sources and analytical techniques, we should be able to advance our understanding of the role of raised blood pressure and its drug treatment on the risks of low bone mineral density and fractures. As elevated blood pressure is highly prevalent and blood pressure-lowering drugs are widely prescribed, even small effects of these exposures on bone health outcomes could be important at a population level.

Automated summary

There are commonalities in the physiologic regulation of blood pressure and bone metabolism, with certain classes of antihypertensive drugs potentially affecting bone mineral density. Current evidence is insufficient to establish causal associations between blood pressure, blood pressure-lowering drugs, and bone health outcomes like osteoporosis and fractures. Advancements in study designs and analytical approaches provide opportunities for more detailed and reliable examination of the relationship between blood pressure and bone health. It is important to consider the strengths and limitations of different data sources and analytical techniques in order to advance our understanding of the impact of elevated blood pressure and its drug treatment on bone health outcomes.