IZUChENIE PLEYOTROPNYKh EFFEKTOV V-ADRENOBLOKATOROV I INGIBITOROV APF NA KOSTNUYu TKAN'

Objective: To investigate the effect of treatment with betablockers (β-AB), inhibitors of angiotensin converting enzyme (ACEI) on bone mineral density (BMD) depending on the risk factors (RF) of osteoporosis. Material and methods. In a retrospective study included 1129 outpatients (1093 women) aged over 40 years, who had the first DXA examination prior to start of the treatment for osteoporosis. Baseline characteristics of pts including data on osteoporosis risk factors (RF) and medication were obtained at the initial visit which had taken place between 2001 and 2011. BMD at the lumbar spine (LS), femoral neck (FN) and total hip (TH) were measured by DXA (Hologic Delphi W). 384 pts have been taking β-AB, ACEI and their combination not less than 6 months before the DXA examination ("users group”), 745 pts. have not been receiving any therapy ("non-users group”). Results. In the "users group” risk of reduction of BMD was lower than in the non-users [RR=1,6 (95 % CI 1.25-2,022) p<0.001], osteoporosis was diagnosed 1,3 times less frequently, and the BMD in LS, FN and TH were significantly higher than these parameters in "non-users group”. The highest BMD were noted in pts on combined therapy. The risk of BMD reduction not depends in both groups on RF such as age, postmenopause duration, presense of early or surgical menopause, low body weight, physical inactivity, previous fractures, fractures in relatives, rheumatoid arthritis, glucocorticoid use or alcohol abuse. In multivariate regression analysis after adjustment with these RF, BMD at all measured locations in users group maintained significantly higher than in non-users. There was no correlation between BMD and duration of β-AB and ACEI therapy. Conclusion Prolonged use of β-AB, ACEI in combination as well as monotherapy could has a protective effect on bone mass regardless of osteoporosis risk factors.

бета-адреноблокаторы, ингибиторы ангиотензинпревращающего фермента, минеральная плотность кости, факторы риска остеопороза

1. Оганов Р.Г., Калинина А.М., Поздняков Ю.М. Профилактическая кардиология. М.: ЗАО МИД «Синергия», 2003. 189 с.

2. Скрипникова И.А., Оганов Р.Г., Остеопороз и сердечно-сосудистые заболевания, обусловленные атеросклерозом у женщин постменопаузального периода: общность поведенческих и социальных факторов риска. Остеопороз и остеопатии 2009; 2; 5-9.

3. Debby den Uyl., Mike T. Nurmohamed, Lilian HD van Tuyl., et. al. (Sub)clinical cardiovascular disease is associated with increased bone loss and fracture risk; a systematic review of the association between cardiovascular disease and osteoporosis. Arthritis Res Ther 2011, 13: R5.

4. Marcovitz P.A., Tran H.H., Franklin B.A., et al. Usefulness of bone mineral density to predict significant coronary artery disease. Am J Cardiol 2005; 96-8; 15: 1059-63.

5. Tanko L.B., Christiansen C., Cox D.A., et al. Relationship between osteoporosis and cardiovascular disease in postmenopausal women. J Bone Miner Res 2005; 20: 1912-20.

6. Rejnmark L., Vestergaard P., Kassem M., et al. Fracture risk in perimenopausal women treated with beta-blockers. Calcif Tissue Int 2004; 75: 365-372.

7. Чазова Л.В., Глазунов И.С. Профилактика ишемической болезни сердца: Методические указания по проведению научного исследования. М.; 1983. с. 99

8. Genant H.K., Wu C.Y., van Kujik C., Nevitt M.: Vertebral fracture assessment using a semiquantitative technique. J. Bone Miner Res 1993; Vol. 8; 1137-1148.

9. Yang S., Nguyen N.D., Center J.R., et al. Association between beta-blocker use and fracture risk: the Dubbo Osteoporosis Epidemiology Study. Bone 2011; 48(3): 451-455

10. Pasco J.A., Henry M.J., Sanders K.M., et al. Beta-adrenergic blockers reduce the risk of fracture partly by increasing bone mineral density: Geelong Osteoporosis Study. J Bone Miner Res 2004; 19: 19-24.

11. Turker S., Karatosun V., Gunai I. Beta-blockers increase bone mineral density. Clin Orthop 2006; 443: 73-74.

12. Schlienger R.G., Kraenzlin M.E., Jick S.S., Meier C.R. Use of beta-blockers and risk of fractures. JAMA 2004; 292: 1326-32.

13. Schoo M., Sturkenboom P., Van Leeuwen J., et al. Use of betablockers is associated with BMD and fracture risk. Bone 2005; 36 S2: 129-130.

14. Ducy P., Amling M., Takeda S. Leptin inhibits bone formation through a hypothalamic relay: a central control of bone mass. Cell 2000; 100: 197-207.

15. Majeska R.J., Minkowitz B., Bastian W., Einhorn T.A. Effects of beta-adrenergic blockade in an osteoblastlike cell line. J Orthop Res 1992; 10: 370-84.

16. Toker. A., Gulcan E., Toker S., etal. Nebivolol might be beneficial in osteoporosis treatment: a hypothesis. TJPR 2009; 8(2): 181-186.

17. H. Lynn, T. Kwok, S.Y. Wong, J. Woo, P.C. Leung. Angiotensin converting enzyme inhibitor use is associated with higher bone mineral density in elderly Chinese. Bone 2006; 34(4): 584-588.

18. Hiruma H., Hiruma Y., Inoue F., Yamaguchi A., Hirose S. Deceleration by angiotensin II of the differentiation and bone formation of rat calvarial osteoblastic cells. J Endocrinol 1998; 156: 543-550.

19. Hatton R., Stimpel M., Chambers T.J. Angiotensin II is generated from angiotensin I by bone cels and stimulates osteoclastic bone resorption in vitro. J Endocrinol 1997; 152: 5-10.