Cardiovascular drugs and bone.

Cardiovascular diseases are common and occur mainly in the elderly in whom osteoporotic fractures also are very common. Because of this, it is of importance to establish whether drugs used in the treatment of cardiovascular diseases affect bone, in order to minimise any possible adverse effects. In the majority of studies, treatment with thiazide diuretics, statins, digoxin, angiotensin-converting enzyme (ACE)-inhibitors, and organic nitrates have not been associated with harmful effects on bone. On the contrary, treatment with these drugs may improve bone strength but because there is a lack of randomised controlled trials (RCTs) with fracture as a primary outcome measure, these drugs should not be prescribed for fracture prevention. In RCTs, treatment with loop diuretics have been shown to increase plasma levels of parathyroid hormone and decrease bone mineral density. In epidemiological studies, treatment with loop diuretics as well as treatment with amiodarone has been associated with an increased risk of fracture. In view of the conflicting results from published studies, no conclusions can be drawn on potential bone effects of treatment with oral anticoagulants, beta-blockers, and calcium channel blockers.