Elevated Blood Pressure, Antihypertensive Medications and Bone Health in the Population: Revisiting Old Hypotheses and Exploring Future Research Directions

Abstract

Blood pressure and bone metabolism appear to share commonalities in their physiologic regulation. Specific antihypertensive drug classes may also influence bone mineral density. However, current evidence from existing observational studies and randomized trials is insufficient to definitely suggest likely causal associations between blood pressure levels and use of blood-pressure lowering drugs on bone health outcomes, particularly on the risks of osteoporosis and fractures. Nevertheless, the availability and access to relevant large-scale biomedical data sources as well as developments in study designs and analytical approaches are providing opportunities to examine the nature of the association between blood pressure and bone health more reliably and in greater detail than has ever been possible. It is unlikely that a single source of data or study design can provide a definitive answer. However, with appropriate considerations of the strengths and limitations of the different data sources and analytical approaches, we should be able to advance our understanding of the role of raised blood pressure and its drug treatment on bone health outcomes. As elevated blood pressure and use of blood pressure-lowering drugs are highly prevalent, even small effects of these exposures on bone health outcomes could be important at a population level.