Hypertension and fracture risk: impact of antihypertensive medications on bone health

ABSTRACT Hypertension and osteoporosis are recognized as highly prevalent chronic conditions within the adult population, both of which have been associated with important public health concerns due to their impact on morbidity rates and healthcare expenditures. An intricate relationship between these disorders has been suggested by emerging evidence, indicating that adverse effects on bone health may be exerted by hypertension through multiple pathophysiological pathways. Furthermore, the modulation of bone metabolism by certain antihypertensive medications has been reported, leading to potential alterations in bone mineral density and modifications in the risk profile for osteoporotic fractures. The objective of this review was to analyze the available evidence on the relationship between hypertension and osteoporosis, focusing on the shared pathophysiological mechanisms and the impact of antihypertensive treatments on bone health. Through the synthesis of existing findings, a deeper understanding of the extent to which bone mineral density and fracture risk are affected by hypertension is sought. Additionally, evidence-based considerations regarding the selection of antihypertensive therapies in individuals at an increased risk for osteoporosis are provided, with the objective of optimizing treatment strategies and mitigating the potential adverse skeletal effects of long-term antihypertensive therapy.