Arterial hypertension and bone health—a literature review

Abstract

The prevalence of hypertension (AH) and osteoporosis is increasing worldwide, which is associated primarily with an increase in the proportion of people over the age of 50. A number of researchers have suggested that the two diseases share a common etiopathogenesis associated with low intake and correspondingly low serum calcium levels, vitamin D and vitamin K deficiency, and deviations in nitric oxide levels. In addition, there are additional prerequisites for the adverse effects of AH on bone tissue. It is known, for example, that higher blood pressure (BP) levels cause greater loss of calcium in the urine. On the other hand, AH is also associated with increased sympathetic tone, vascular disorders, abnormal cytokine levels, and increased activity of the renin-angiotensin-aldosterone system (RAAS) at the systemic and local levels. In addition, the number of falls, which are a leading factor in the occurrence of fractures, in patients with AH may be increased. A prerequisite for this is the presence of syncope associated with decreased baroreflex sensitivity or orthostatic hypotension caused by antihypertensive drugs. The potential link between AH and bone health has long been discussed, but the results of numerous clinical trials remain mixed. The presence of some inconsistencies in the literature may be related to differences in the stage and severity of AH among the studied populations, as well as to the control of AH. On the other hand, antihypertensive drugs, which have specific effects on different target organs, may further modulate bone homeostasis. However, not all studies clarify whether patients receive therapy for elevated AH.