Available online 4 July 2025, 101607

Author links open overlay panel, , , , , , , , , , , , , , , , , , , ABSTRACTIntroduction

Hypertension (HT) and osteoporosis (OP) are common chronic diseases that often coexist in postmenopausal women. This study aimed to investigate the association between the use of antihypertensive medications and the presence of OP.

Methods

We retrospectively analyzed the medical records of 4166 postmenopausal women. Demographic data, age, weight, height, comorbidities, medications and bone mineral density values were collected for all patients screened/followed for OP between 2023 and 2024.

Results

Out of 4166 postmenopausal women, 1659 (39.8%) were diagnosed with OP. After adjusting for potential confounders using binary logistic regression, diabetes mellitus [OR=0.785 (95% CI=0.667-0.925) p=0.004] and hyperlipidemia [OR=0.826 (95% CI=0.698-0.978) p=0.026] were negatively associated with OP. Among the antihypertensive medications (N=2144); furosemide use [OR=1.918 (95% CI=1.157-3.182) p=0.012] was positively associated with OP, while thiazide use showed a negative association [OR=0.769 (95% CI=0.619-0.954) p=0.017].

Conclusion

Thiazide use was associated with a lower likelihood of OP, while furosemide use was linked to increased odds (about 1.9 times). Further research with larger samples and stratified analyses of antihypertensive classes is warranted to better understand these associations.

Section snippetsINTRODUCTION

Osteoporosis (OP) is a major public health concern characterized by decreased bone mineral density (BMD) and deterioration of bone micro-architecture. It increases the risk of fragility fractures, which are associated with significant healthcare costs, morbidity, and mortality.1, 2, 3 Its prevalence continues to rise with population aging 1 and approximately 30% of postmenopausal women in the European Union and the United States are affected.2 Further, 40% of these women and 30% of osteoporotic

METHODS

This study was performed in two hospitals (Hacettepe University Medical School and Abdurrahman Yurtaslan Oncology Training and Research Hospital). Data of 4166 postmenopausal women - who had been screened/followed for OP between January 2023 and May 2024 - were collected. Demographic data including age, weight, height, body mass index (BMI), presence of chronic comorbidities (e.g., OP, HT, diabetes mellitus (DM), hyperlipidemia (HL)) and drug usage were acquired from the hospitals’ electronic

RESULTS

Out of 4166 postmenopausal women, 2111 (50.6%) of them had HT and 1659 (39.8%) of them had OP. Comparison of various characteristics between individuals with and without OP are shown in Table 1. Notably, those with OP were older and had lower mean values for weight, height, and BMI compared to those without OP (all p<0.05). Additionally, proton pump inhibitor (PPI), selective serotonin reuptake inhibitors (SSRI) and clopidogrel use were higher, whereas presence of DM was lower among individuals

DISCUSSION

In our study, we investigated the association of antihypertensive drug use with OP in postmenopausal women. Our results showed that thiazides seem to exhibit a protective effect, whereas furosemide had a negative effect on OP.

Our results regarding the relationship between antihypertensive drugs and OP align with (and expand) the existing literature. In line with the previous studies,13, 14, 15, 16, 17 thiazide diuretics seemed to be associated with a protective effect on OP. A randomized,

DECLARATIONS

Human and Animal Rights and Informed Consent This study was conducted in accordance with the ethical standards of the institutional research committee and according to the guidelines of the Declaration of Helsinki. The study was approved by the local Ethics Committee of Hacettepe University Medical School. No animals were involved in the study. For this type of study formal consent is not required.

FUNDING

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of competing interest

The authors declare no conflict of interest

REFERENCES (35)D.A. McCarron et al.Enhanced parathyroid function in essential hypertension: a homeostatic response to a urinary calcium leak

Hypertension

(1980)

E.W. Young et al.Urinary calcium excretion in essential hypertension

J Lab Clin Med

(1992)

H. Shimizu et al.Angiotensin II accelerates osteoporosis by activating osteoclasts

FASEB J

(2008)

G. GrassiThe sympathetic nervous system in hypertension: roadmap update of a long journey

Am J Hypertens

(2021)

R. Zhang et al.Advanced progress of the relationship between antihypertensive drugs and bone metabolism

Hypertension

(2023)

J.I. Barzilay et al.The impact of antihypertensive medications on bone mineral density and fracture risk

Curr Cardiol Rep

(2017)

A.Z. LaCroix et al.Low-dose hydrochlorothiazide and preservation of bone mineral density in older adults. A randomized, double-blind, placebo-controlled trial

Ann Intern Med

(2000)

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© 2025 The International Society for Clinical Densitometry. Published by Elsevier Inc.