The effect of β-blockers on bone metabolism as potential drugs under investigation for osteoporosis and fracture healing

Abstract

Background: β-Adrenergic receptor antagonists (β-blockers) have a well-recognised antihypertensive action that is mediated through a reduction in cardiac output and in the release of renin from the kidneys and inhibition of the action of endogenous catecholamines on β-adrenergic receptors. This class of drugs has been shown to reduce the incidence of cardiovascular disease. Recent evidence suggests that β-blockers may also have an effect on bone structure, metabolism and fracture healing. Objective: This paper reviews in vitro and in vivo data that suggest β-blockers have primarily an anabolic effect on bone metabolism. Results: The sympathetic nervous system has a catabolic effect on bone, and in vitro studies have shown that adrenergic agonists stimulate bone resorption. The β-blocker propranolol has been shown to increase bone formation in ovariectomised female rats. Also, recent observational clinical studies provide evidence to show that β-blockers are associated with reduction in fracture risk in both men and women. Conclusion: Although there are some controversial studies, most research concludes that β-blockers show promise in the treatment of osteoporosis and fracture healing.