ACE Inhibitors May Prevent Bone Loss in Men



SAN DIEGO – Angiotensin-converting enzyme inhibitor therapy may reduce the risk of age-related bone loss in elderly men.

A retrospective analysis of longitudinal data from the prospective Health ABC (Dynamics of Health, Aging and Body Composition Study) found that femoral neck bone mineral density was significantly greater in elderly men on an ACE inhibitor for 5 or more years for treatment of hypertension than in those who were not on long-term ACE inhibitor therapy, Dr. Nahid Rianon reported at the annual meeting of the American Society for Bone and Mineral Research.

This secondary analysis of Health ABC involved 583 men with a mean age of 83 years. At 10-year follow-up, femoral neck bone mineral density was 0.04 g/cm2 greater in the 137 subjects on an ACE inhibitor for at least 5 years than in men not on long-term therapy with a drug in this class.

Of note, the same magnitude of improvement in femoral neck bone mineral density was seen after just 5 years of ACE inhibitor therapy. In other words, no further divergence in bone mineral density occurred during years 5-10.

These study findings warrant confirmation in a prospective clinical trial featuring analysis of bone markers, which wasn’t done in Health ABC. Osteoporosis and hypertension are two major age-related chronic diseases that at present are managed separately using different classes of drugs. If ACE inhibitors can be shown to be beneficial in both of these extremely common diseases, management would be considerably simplified, observed Dr. Rianon of the University of Texas, Houston.

The finding that long-term ACE inhibitor therapy appears to prevent age-related bone loss in older men has mechanistic plausibility, the physician continued. These drugs inhibit production of angiotensin II, a hormone that affects bone by binding to the angiotensin-1 and angiotensin-2 receptors expressed in osteoblasts, among other sites. And angiotensin-1 and angiotensin-2 expression appears to promote receptor-activated nuclear factor–kappaB ligand activity, which enhances bone loss.

Health ABC is sponsored by the National Institute on Aging. Dr. Rianon declared having no financial conflicts.