Beta-Blockers: Effects on Bone Mineral Density and Fracture Risk

In addition to their action on a decrease in blood pressure levels and a reduction of mortality in individuals with vascular disease, β-blockers can have beneficial effects on osteoporosis. The relationship between the sympathetic nervous system and bone metabolism is well known. There have been reports of adrenergic receptors in osteoblasts and of the presence of sympathetic nerve fibers in bone. The central infusion of leptin inhibits osteoblast activity through hypothalamic sympathetic activation resulting in decreased bone mass. This leads to the consideration of the use of β-blockers in the treatment of osteoporosis. Retrospective studies (case-control, cohort studies) followed, which showed a beneficial effect of the β-blockers on the reduction of fractures, although not all the results are consistent. In 9 published studies, a protective effect was shown in 7. The reduction of risk fracture was over 30 %. The aim of this article is to review the available evidence, experimental and clinical, of the effect of β-blockers on bone mass and the reduction of fractures. These drugs may be useful for the treatment of osteoporosis in patients with vascular disease