Angiotensin Receptor Blocker is Associated with A Lower Fracture Risk: An Updated Systematic Review and Meta-Analysis

Abstract Background The angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) are prevalently used in the treatment of hypertension. Hypertension often presents with osteoporosis. However, over the past decade, it has been unclear whether long-term use of ACEI/ARB reduces fracture risk. This meta-analysis aims to investigate the potential clinical effects of ACEI/ARB on osteoporosis fracture (OF). Methods This meta-analysis was identified through PubMed, EMBASE, Cochrane Library, and Web of Science. Related studies about ACEI/ARB with the risk of fracture were published from inception to September, 2021. Results Nine qualified prospective designed studies, involving 3,649,785 subjects, were included in this analysis. Overall, the RR of ACEI compared with the non-users were 0.98 (95% CI: 0.88, 1.10; P < 0.001) for composite fractures and 0.96 (95% CI: 0.87, 1.05; P = 0.048) for hip fractures; the RR of ARB compared to the non-users were 0.82 (95% CI: 0.73, 0.91; P < 0.001) for composite fractures and 0.85 (95% CI: 0.74, 0.97; P = 0.028) for hip fractures. Furthermore, in the subgroup analysis, male may benefit from ARB (RR = 0.65, 95% CI 0.49, 0.89, P = 0.028), and the European may also benefit from ARB (RR = 0.86, 95% CI 0.80, 0.93, P = 0.015). Conclusions ACEI usage will not decrease the risk of osteoporosis fracture. On the contrary, ARB usage can decrease the risk of total fracture and hip fracture, especially for the male and European. Compared with ACEI, for patients at higher risk of fracture in cardiovascular diseases such as hypertension, the protective effect of ARB should be considered.