Angiotensin receptor–neprilysin inhibitor versus angiotensin-converting enzyme inhibitor for osteoporosis risk in patients with heart failure

This research presents a real-world study investigating the association between angiotensin receptor-neprilysin inhibitor (ARNI) versus angiotensin-converting enzyme inhibitors (ACEI) use and the risk of osteoporosis in patients with heart failure (HF). During the study period from 2017 to 2022, HF patients were classified as users of ACEI or ARNI based on prescription records. After 1:1 propensity score matching, a total of 12,808 HF patients were included, with 6,404 patients in each treatment group (ACEIs vs. ARNIs). The unadjusted model included only treatment exposure, whereas the adjusted model accounted for potential confounders. In the risk factor analysis for osteoporosis among patients with HF, use of ARNI was associated with a significantly lower risk of osteoporosis compared with ACEI in the multivariable-adjusted model (adjusted HR [aHR] 0.6, 95% CI 0.4-0.88, p = 0.0092). Among HF patients, ARNI use was associated with a lower risk of osteoporosis than ACEI use.