RAAS Inhibitors Do Not Increase Fracture Risk, Osteoporosis in Postmenopausal Women

Osteoporosis in the femur
Osteoporosis in the femur
RAAS inhibitors do not have a deleterious effect on skeletal health in postmenopausal women.

The following article is part of conference coverage from the 2018 American College of Rheumatology and Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting in Chicago, Illinois. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from ACR/ARHP 2018 .

CHICAGO — Renin angiotensin aldosterone system (RAAS) inhibitors do not appear to negatively affect skeletal health or increase the likelihood of osteoporosis in postmenopausal women, according to study data presented at the 2018 ACR/ARHP Annual Meeting, held October 19-24, in Chicago, Illinois.

Investigators abstracted patient data from the Women’s Health Initiative Observational Study and Clinical Trials (n=155,565). Bone mineral density and body composition analyses were performed for 11,437 women by means of a dual energy x-ray absorptiometry measurement. Investigators also captured RAAS inhibitor use over time, fracture outcomes, and additional demographic and clinical variables including medication use associated with osteoporosis.

At the baseline study visit, 13,749 participants (9%) were users of RAAS inhibitors compared with 141,816 nonusers (91%). Across 16.8 years of follow-up, 34,276 total fractures were recorded, among which 2912 occurred in baseline users of RAAS inhibitors and 31,364 occurred in baseline nonusers. In the unadjusted model, there was a positive association between RAAS inhibitor use with all fragility fractures (hazard ratio, 1.05; 95% CI, 1.01-1.09). However, a multivariable model that incorporated baseline bone mineral density identified no significant associations between RAAS inhibitor use and the occurrence of fractures. RAAS inhibitors were also not associated with any specific fracture site or with changes in bone mineral density in the total hip, femoral neck, or lumbar spine from baseline to 6-years of follow-up. Additionally, changes in total body mass, lean body mass, or fat mass from baseline to 3 or 6 years of follow-up were not associated with RAAS inhibitors.

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These data indicate that RAAS inhibitors do not have a deleterious effect on skeletal health in postmenopausal women. Future research is necessary to explore the impact of individual RAAS inhibitor classes on specific measures of bone health.

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Carbone L, Vassan S, Prentice R, et al. The association of RAAS inhibitor use with osteoporosis: findings from the women’s health initiative. Presented at: 2018 American College of Rheumatology and Association of Rheumatology Professionals (ACR/ARHP) Annual Meeting; October 19-24, 2018; Chicago, IL. Abstract 1146.

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