Context Animal studies suggest that the β-blocker propranolol increases
bone formation, but data on whether use of β-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 β-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 30 601 case patients aged 30 to 79 years with
an incident fracture diagnosis between 1993 and 1999 and 120 819 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 β-blockers
or a combination of β-blockers with thiazides.
Results The most frequent fractures were of the hand/lower arm (n = 12 837
[42.0%]) and of the foot (n = 4627 [15.1%]). Compared with patients who did
not use either β-blockers or thiazide diuretics, the OR for current use
of β-blockers only (≥3 prescriptions) was 0.77 (95% confidence interval
[CI], 0.72-0.83); for current use of thiazides only (≥3 prescriptions),
0.80 (95% CI, 0.74-0.86); and for combined current use of β-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 β-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 β-blockers