The «side» effect on bone: how antihypertensive drugs influence osteoporosis?
https://doi.org/10.37586/2686-8636-2-2026-197-206
Abstract
Hypertension and osteoporosis are among the most prevalent chronic non-communicable diseases in older adults, often determining their quality of life, disability rates, and mortality. According to large-scale international epidemiological studies, the prevalence of hypertension in adults aged 18 years or older reaches 31 %, while low bone mass (osteopenia/osteoporosis) affects more than 40 % of older individuals. In recent decades, it has been demonstrated that the risk of an osteoporotic fracture in patients with hypertension is 1.33 times higher than in those without hypertension, and the association between hypertension and fractures is stronger in women than in men. In this context, antihypertensive therapy becomes particularly important in the management of patients with both hypertension and bone disorders, which requires evaluating its effects not only on cardiovascular outcomes but also on prevention of osteoporosis and low-energy fractures. We have reviewed current experimental and clinical studies, including meta-analyses, to synthesize the available knowledge in this field. The strongest evidence points to a protective effect on bone metabolism for thiazide diuretics, angiotensin receptor blockers (ARBs), and selective beta-blockers, which may be recommended for patients with hypertension and osteopenia/osteoporosis. Drugs whose use may be associated with an increased risk of developing or worsening osteopenia and osteoporosis include loop diuretics and alpha-blockers; this requires particular attention to fracture risk assessment and prevention when these agents are prescribed. Overall, the data from most studies remains heterogeneous, and their results often conflict. Therefore, further research is needed on the effects of antihypertensive drugs on bone metabolism.
About the Authors
Yu. V. Kotovskaya
Federal State Autonomous Educational Institution of Higher Education «N. I. Pirogov Russian National Research Medical University» of the Ministry of Health of the Russian Federation. Russian Gerontology Research and Clinical Center
Russian Federation
Russian Federation
Moscow
A. V. Unkovskiy
Federal State Autonomous Educational Institution of Higher Education «N. I. Pirogov Russian National Research Medical University» of the Ministry of Health of the Russian Federation. Russian Gerontology Research and Clinical Center
Russian Federation
Russian Federation
Unkovskiy Aleksey Vladimirovich
Moscow
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Kotovskaya Yu.V., Unkovskiy A.V. The «side» effect on bone: how antihypertensive drugs influence osteoporosis? Russian Journal of Geriatric Medicine. 2026;(2):197-206. (In Russ.) https://doi.org/10.37586/2686-8636-2-2026-197-206
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