The impact of Renin-Angiotensin System Inhibitors on bone fracture risk: a nationwide nested case-control study
Abstract Background The therapeutic efficacy of renin-angiotensin system inhibitors (RASi) in elderly patients with hypertension and at risk of fractures has been in the limelight because of accumulating evidence that localized RAS activation in bone tissue leads to osteoclastic bone resorption, res...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-01-01
|
| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-023-07102-5 |
| _version_ | 1797363713048576000 |
|---|---|
| author | Kwang Min Kim Eun Jung Hwang Sangjin Lee Jeong-Hyun Yoon |
| author_facet | Kwang Min Kim Eun Jung Hwang Sangjin Lee Jeong-Hyun Yoon |
| author_sort | Kwang Min Kim |
| collection | DOAJ |
| description | Abstract Background The therapeutic efficacy of renin-angiotensin system inhibitors (RASi) in elderly patients with hypertension and at risk of fractures has been in the limelight because of accumulating evidence that localized RAS activation in bone tissue leads to osteoclastic bone resorption, resulting in osteoporosis. This study set out to investigate the association between RASi use and fracture incidence in a large cohort. Methods We employed a nested case–control design to investigate the association between RASi use and newly developed fractures. A case was defined as a patient newly diagnosed with a fracture between January 2004 and December 2015. We selected 1,049 cases and controls using 1:1 propensity score matching. Conditional logistic regression analysis was conducted to estimate the association between RASi exposure and fracture incidence. Results Overall, RASi usage was significantly associated with lower odds for fracture incidence (ever-users vs never-users: OR, 0.73; 95% CI, 0.59–0.91). We found that ARB-only users experienced fewer fractures than RASi-never users (OR, 0.65; 95% CI, 0.49–0.86), whereas ACEi-only users or ARB/ACEi-ever users did not. In subgroup analysis, RASi-ever users without cerebrovascular disease, those with a BMI exceeding 23, and statin exposure had significantly lower ORs. Conclusions The present study established a significant association between RASi use and reduced fracture incidence, thus highlighting the potential clinical utility of RASi use as a preventive strategy in elderly patients at risk for osteoporotic fractures. |
| first_indexed | 2024-03-08T16:25:06Z |
| format | Article |
| id | doaj.art-10990194f346433d862c6d33a1dee7f8 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-03-08T16:25:06Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-10990194f346433d862c6d33a1dee7f82024-01-07T12:04:29ZengBMCBMC Musculoskeletal Disorders1471-24742024-01-0125111010.1186/s12891-023-07102-5The impact of Renin-Angiotensin System Inhibitors on bone fracture risk: a nationwide nested case-control studyKwang Min Kim0Eun Jung Hwang1Sangjin Lee2Jeong-Hyun Yoon3Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of MedicineCollege of Pharmacy and Research Institute for Drug Development, Pusan National UniversityDepartment of Statistics, College of Natural Science, Pusan National UniversityCollege of Pharmacy and Research Institute for Drug Development, Pusan National UniversityAbstract Background The therapeutic efficacy of renin-angiotensin system inhibitors (RASi) in elderly patients with hypertension and at risk of fractures has been in the limelight because of accumulating evidence that localized RAS activation in bone tissue leads to osteoclastic bone resorption, resulting in osteoporosis. This study set out to investigate the association between RASi use and fracture incidence in a large cohort. Methods We employed a nested case–control design to investigate the association between RASi use and newly developed fractures. A case was defined as a patient newly diagnosed with a fracture between January 2004 and December 2015. We selected 1,049 cases and controls using 1:1 propensity score matching. Conditional logistic regression analysis was conducted to estimate the association between RASi exposure and fracture incidence. Results Overall, RASi usage was significantly associated with lower odds for fracture incidence (ever-users vs never-users: OR, 0.73; 95% CI, 0.59–0.91). We found that ARB-only users experienced fewer fractures than RASi-never users (OR, 0.65; 95% CI, 0.49–0.86), whereas ACEi-only users or ARB/ACEi-ever users did not. In subgroup analysis, RASi-ever users without cerebrovascular disease, those with a BMI exceeding 23, and statin exposure had significantly lower ORs. Conclusions The present study established a significant association between RASi use and reduced fracture incidence, thus highlighting the potential clinical utility of RASi use as a preventive strategy in elderly patients at risk for osteoporotic fractures.https://doi.org/10.1186/s12891-023-07102-5Renin-angiotensin system inhibitorsAngiotensin II receptor blockersFractureDefined daily dosesNested case–control study |
| spellingShingle | Kwang Min Kim Eun Jung Hwang Sangjin Lee Jeong-Hyun Yoon The impact of Renin-Angiotensin System Inhibitors on bone fracture risk: a nationwide nested case-control study BMC Musculoskeletal Disorders Renin-angiotensin system inhibitors Angiotensin II receptor blockers Fracture Defined daily doses Nested case–control study |
| title | The impact of Renin-Angiotensin System Inhibitors on bone fracture risk: a nationwide nested case-control study |
| title_full | The impact of Renin-Angiotensin System Inhibitors on bone fracture risk: a nationwide nested case-control study |
| title_fullStr | The impact of Renin-Angiotensin System Inhibitors on bone fracture risk: a nationwide nested case-control study |
| title_full_unstemmed | The impact of Renin-Angiotensin System Inhibitors on bone fracture risk: a nationwide nested case-control study |
| title_short | The impact of Renin-Angiotensin System Inhibitors on bone fracture risk: a nationwide nested case-control study |
| title_sort | impact of renin angiotensin system inhibitors on bone fracture risk a nationwide nested case control study |
| topic | Renin-angiotensin system inhibitors Angiotensin II receptor blockers Fracture Defined daily doses Nested case–control study |
| url | https://doi.org/10.1186/s12891-023-07102-5 |
| work_keys_str_mv | AT kwangminkim theimpactofreninangiotensinsysteminhibitorsonbonefractureriskanationwidenestedcasecontrolstudy AT eunjunghwang theimpactofreninangiotensinsysteminhibitorsonbonefractureriskanationwidenestedcasecontrolstudy AT sangjinlee theimpactofreninangiotensinsysteminhibitorsonbonefractureriskanationwidenestedcasecontrolstudy AT jeonghyunyoon theimpactofreninangiotensinsysteminhibitorsonbonefractureriskanationwidenestedcasecontrolstudy AT kwangminkim impactofreninangiotensinsysteminhibitorsonbonefractureriskanationwidenestedcasecontrolstudy AT eunjunghwang impactofreninangiotensinsysteminhibitorsonbonefractureriskanationwidenestedcasecontrolstudy AT sangjinlee impactofreninangiotensinsysteminhibitorsonbonefractureriskanationwidenestedcasecontrolstudy AT jeonghyunyoon impactofreninangiotensinsysteminhibitorsonbonefractureriskanationwidenestedcasecontrolstudy |