Association between renin-angiotensin-aldosterone system blockade and future osteoporotic fracture risk in hypertensive population a population-based cohort study in Taiwan

Chang I. Chen, Jong Shiuan Yeh, Nai Wen Tsao, Fen Yen Lin, Chun Ming Shih, Kuang Hsing Chiang, Yung Ta Kao, Yu Ann Fang, Lung Wen Tsai, Wen Chi Liu, Hironori Nakagami, Ryuichi Morishita, Yi Jie Kuo, Chun Yao Huang

Research output: Contribution to journalArticle

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Abstract

Tissue renin-angiotensin-aldosterone system (RAAS) activation in sites of osteoporosis had been demonstrated in animal studies; however, the possibility of RAAS blockade to prevent future osteoporotic fracture had rarely been verified in clinical studies. We Used the Taiwan Longitudinal Health insurance database 2000 to 2008, the cohort study comprised patients age over 40 with a recorded new diagnosis of hypertension between January 1, 2000 to December 31, 2008, in addition, patients who had diagnosis of osteoporosis before the date of cohort enter were excluded. After the definite diagnosis of hypertension, each patient was followed until osteoporotic fracture happened or the end of 2008. The occurrence of osteoporotic fracture was evaluated in patients who either were or without taking RAAS blockade agents. Cox proportional hazard regressions were used to evaluate the osteoporotic fracture incidence after adjusting for known confounding factors. In total, 57,132 hypertensive patients comprised the study cohort. Our study results showed that the incidence of osteoporosis fracture in the whole cohort was significantly higher in the RAAS blockade non-user group than the user group. This phenomenon was observed in both sex and all age categories. Sensitivity analysis further showed the concordant lower osteoporosis fracture risk in patients with various RAAS blockers usage durations; the risk of osteoporosis fracture was the lowest in those drug use >365 days when compared with the non-user cohort. In conclusion, our study result demonstrated the lower future osteoporotic fracture risk in hypertensive subjects who received long term RAAS blocker treatment. Abbreviations: ACEI = angiotensin converting enzyme inhibitor, ARB = angiotensin II receptor blockers, AT1R = angiotensin II type 1 receptor, BMD = bone mineral density, CI = confidence interval, COPD = chronic obstructive pulmonary disease, HR = hazard ratio, ICD-9 = International Classification of Disease, 9th Revision, MRA = mineralocorticoid receptor antagonist, RAAS = reninangiotensin-aldosterone system, RANKL = receptor activator of NF-κB ligand.

Original languageEnglish
Article numbere8331
JournalMedicine (United States)
Volume96
Issue number46
DOIs
Publication statusPublished - Nov 1 2017

Fingerprint

Osteoporotic Fractures
Renin-Angiotensin System
Taiwan
Cohort Studies
Osteoporosis
Population
International Classification of Diseases
Chronic Obstructive Pulmonary Disease
Hypertension
Mineralocorticoid Receptor Antagonists
Angiotensin Type 1 Receptor
Angiotensin Receptor Antagonists
Incidence
Health Insurance
Aldosterone
Angiotensin-Converting Enzyme Inhibitors
Bone Density
Databases
Confidence Intervals
Ligands

Keywords

  • Hypertension
  • Osteoporotic fracture
  • Renin-angiotensin-aldosterone system

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Association between renin-angiotensin-aldosterone system blockade and future osteoporotic fracture risk in hypertensive population a population-based cohort study in Taiwan. / Chen, Chang I.; Yeh, Jong Shiuan; Tsao, Nai Wen; Lin, Fen Yen; Shih, Chun Ming; Chiang, Kuang Hsing; Kao, Yung Ta; Fang, Yu Ann; Tsai, Lung Wen; Liu, Wen Chi; Nakagami, Hironori; Morishita, Ryuichi; Kuo, Yi Jie; Huang, Chun Yao.

In: Medicine (United States), Vol. 96, No. 46, e8331, 01.11.2017.

Research output: Contribution to journalArticle

Chen, Chang I. ; Yeh, Jong Shiuan ; Tsao, Nai Wen ; Lin, Fen Yen ; Shih, Chun Ming ; Chiang, Kuang Hsing ; Kao, Yung Ta ; Fang, Yu Ann ; Tsai, Lung Wen ; Liu, Wen Chi ; Nakagami, Hironori ; Morishita, Ryuichi ; Kuo, Yi Jie ; Huang, Chun Yao. / Association between renin-angiotensin-aldosterone system blockade and future osteoporotic fracture risk in hypertensive population a population-based cohort study in Taiwan. In: Medicine (United States). 2017 ; Vol. 96, No. 46.
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AU - Shih, Chun Ming

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