Association between beta-blocker use and fracture risk: The Dubbo Osteoporosis Epidemiology Study

IntroductionIn animal model, mice treated with beta-blockers (BB) had increased bone mass. In humans, high bone mass is associated with reduce fracture risk. The present study sought to test the hypothesis that BB use is associated with reduced fracture risk.Materials and methodsData from 3488 participants (1285 men) aged 50 years and above in the Dubbo Osteoporosis Epidemiology Study (DOES) were analyzed. Baseline characteristics of participants were obtained at the initial visit which had taken place between 1989 and 1993. Bone mineral density (BMD) at the lumbar spine and femoral neck was measured by dual energy X-ray absorptiometry (GE-LUNAR Corp, Madison, WI). Two hundred and sixty two (20%) men and 411 (19%) women had been on BB, as ascertained by direct interview and verification with medication history. The incidence of fragility fractures was ascertained during the follow-up period (1989–2008).ResultsIn men, BB use was associated with higher BMD at the femoral neck (0.96 versus 0.92 g/cm2, P < 0.01), higher lumbar spine (1.32 versus 1.25 g/cm2, P < 0.01), and lower fracture risk than those not on BB (odds ratio [OR]: 0.49; 95% CI: 0.32–0.75). In women, BB users also had higher femoral neck BMD (0.83 versus 0.81 g/cm2, P < 0.01), higher lumbar spine BMD (1.11 versus 1.06 g/cm2, P < 0.01), and lower risk of fracture than non-users (OR 0.68, 95% CI: 0.53–0.87). The associations between BB use and fracture risk were independent of age, BMD, and clinical risk factors. Subgroup analysis suggested that the association was mainly found in selective BB, not in non-selective BB.ConclusionBeta-blockers use, particularly selective BB, was associated with reduced fracture risk in both men and women, and the association was independent of BMD.

Research Highlights
► Beta-blocker use was associated with increased BMD.
► Beta-blocker users had lower fracture risk.
► The association between beta-blockers and fracture was independent of BMD.