β-blocker prescription is associated with lower cumulative risk of knee osteoarthritis and knee pain consultations in primary care: a propensity score-matched cohort study

Objectives: To examine the association between beta-blocker prescription and first primary-care consultation for knee OA, hip OA, knee pain and hip pain. Methods: Data source: Clinical Practice Research Datalink. Participants aged >= 40 years in receipt of new oral beta-blocker prescriptions were propensity score (PS) matched to an unexposed control. Cox proportional hazard ratios (HRs) and 95% CIs were calculated, and adjusted for non-osteoporotic fractures, number of primary-care consultations for knee or hip injury, and, the number of primary-care consultations, out-patient referrals and hospitalizations in the 12 months preceding cohort entry. Analysis was stratified according to beta-blocker class and for commonly prescribed drugs. P < 0.05 was considered statistically significant. Results: A total of 111 718 beta-blocker-exposed participants were 1:1 PS matched to unexposed controls. beta-blocker prescription was associated with reduced cumulative risk of knee OA, knee pain, and hip pain consultations [with a HR (95% CI) of 0.90 (0.83, 0.98), 0.88 (0.83, 0.92) and 0.85 (0.79, 0.90), respectively]. Propranolol and atenolol were associated with a lower incidence of knee OA and knee pain consultations with a HR of between 0.78 and 0.91.beta-blockers were associated with reduced incidence of consultation for large-joint lower-limb OA/pain as a composite outcome, defined as the earliest of knee OA, knee pain, hip OA or a hip pain consultation [with a HR (95% CI) of 0.87 (0.84, 0.90)]. Conclusion: Commonly used beta-blockers have analgesic properties for musculoskeletal pain. Atenolol might be a therapeutic option for OA and cardiovascular co-morbidities in which beta-blockers are indicated, while propranolol may be suitable for people with co-morbid anxiety. A confirmatory randomized controlled trial is needed before clinical practice is changed.

Automated summary

This study examined the association between beta-blocker prescription and first primary-care consultation for knee osteoarthritis, hip osteoarthritis, knee pain, and hip pain. The results showed that beta-blocker use was associated with a reduced risk of musculoskeletal pain-related consultations.