Use of β-blockers and risk of fractures

Context Animal studies suggest that the beta-blocker propranolol increases bone formation, but data on whether use of beta-blockers (with or without concomitant use of thiazide diuretics) is associated with reduced fracture risk in humans are limited. Objective To determine whether use of beta-blockers alone or in combination with thiazides is associated with a decreased risk of fracture in adults. Design, Setting, and Participants Case-control analysis using the UK General Practice Research Database (GPRD). The study included 30601 case patients aged 30 to 79 years with an incident fracture diagnosis between 1993 and 1999 and 120819 controls, matched to cases on age, sex, calendar time, and general practice attended. Main Outcome Measures Odds ratios (ORs) of having a fracture in association with use of beta-blockers or a combination of beta-blockers with thiazides. Results The most frequent fractures were of the hand/lower arm (n=12837 [42.0%]) and of the foot (n=4627 [15.1%]). Compared with patients who did not use either beta-blockers or thiazide diuretics, the OR for current use of beta-blockers only (greater than or equal to3 prescriptions) was 0.77 (95% confidence interval [CI], 0.72-0.83); for current use of thiazides only (greater than or equal to3 prescriptions), 0.80 (95% CI, 0.74-0.86); and for combined current use of beta-blockers and thiazides, 0.71 (95% CI, 0.64-0.79). Data were adjusted for smoking; body mass index; number of practice visits; and use of calcium channel blockers, angiotensin-converting enzyme inhibitors, antipsychotics, antidepressants, statins, antiepileptics, benzodiazepines, corticosteroids, and estrogens. Conclusions Our data suggest that current use of beta-blockers is associated with a reduced risk of fractures, taken alone as well as in combination with thiazide diuretics. Many elderly patients with hypertension who are at risk of developing osteoporosis may potentially benefit from combined therapy with beta-blockers and thiazides.