Association of β-adrenergic receptor blockers use with the risk of fracture in adults: a systematic review and meta-analysis.

Background: Studies have shown that beta-antagonists, an antihypertensive drug, may be associated with fracture risk in adult users. However, this conclusion remains controversial. This meta-analysis was used to explore the association between beta-receptor antagonist use and fracture risk in adult patients.

Methods: We searched Embase, Medline, PubMed, and Web of Science; finally, 16 articles were identified, and the extracted odds ratio (OR), hazard ratio (HR), and 95% confidence interval (95% CI) were used to estimate the association between beta-blockers and the risk of fracture in adult patients. All the results are adjusted. Sensitivity analysis and Egger's test were employed to assess the stability of the results and potential publication bias.

Results: We included eight cohort studies, one of which was only used for subgroup analysis because it only discussed the male and female groups separately and did not discuss the combined population. Thus, we included seven studies in which cohort studies did not find an association between beta-receptor antagonists and fracture risk, the HR is 0.96 (95% CI: 0.88-1.05; P = 0.41). Nine case-control studies included 156,437 beta-blockers users and 432,288 non-users for analysis showed that beta-receptor antagonists would reduce the risk of fracture in middle-aged and elderly users, the OR is 0.86 (95% CI: 0.77-0.95; P < 0.0001). In the subgroup analysis by the sites of fracture, no association was found between beta-receptor antagonists and fracture risk. However, in analyzing groups stratified by gender, beta-receptor antagonists reduce the fracture risk.

Conclusion: In cohort studies, no association was found between beta-receptor antagonists and fracture risk. However, beta-receptor antagonists have been shown to reduce the risk of fractures in adult users in case-control studies. The results of this study need careful interpretation for the reason that case-control studies are inferior to cohort studies in determining cause and effect and the lack of enough randomized controlled trials (RCTs).