Researchers studied how two types of blood pressure medications affect bone health in older Irish adults. They found that people taking a medication called ARBs (angiotensin receptor blockers) had stronger bones and less bone breakdown compared to those not taking the medication. Interestingly, a similar drug called ACE inhibitors didn’t show the same benefit. The study included over 1,600 people aged 60 and older and measured their bone density and bone turnover markers. While these results are promising, the researchers say more studies are needed to confirm whether ARBs truly protect bones or if other factors explain the difference.

The Quick Take

  • What they studied: Whether two common blood pressure medications (ARBs and ACE inhibitors) affect how strong bones are and how quickly bones break down in older adults
  • Who participated: 1,692 Irish adults aged 60 and older (average age 70), about 59% women, who were not being treated for osteoporosis. About 40% were taking one of these blood pressure medications
  • Key finding: People taking ARBs had noticeably stronger bones at the hip and spine compared to those not taking the medication. They also had lower levels of a marker that shows bone breakdown. ACE inhibitors showed no similar benefit
  • What it means for you: If you take an ARB for blood pressure, your bones may be getting extra protection. However, this doesn’t mean you should start taking ARBs just for bone health—talk to your doctor about what’s best for your overall health. More research is needed to confirm these findings

The Research Details

This was a cross-sectional study, which means researchers looked at a large group of people at one point in time and compared those taking different medications. The study used data from the TUDA cohort, a group of Irish adults aged 60 and older. Researchers measured bone density (how thick and strong bones are) at three locations: the hip, the neck of the thighbone, and the lower spine. They also measured bone turnover markers—special proteins in the blood that show how fast bones are breaking down and being rebuilt.

The researchers carefully compared people taking ARBs to those not taking them, and separately compared people taking ACE inhibitors to those not taking them. They adjusted their analysis for many other factors that could affect bone health, including age, sex, weight, vitamin D levels, kidney function, physical activity, and other medications people were taking. This helps ensure that any differences they found were actually related to the blood pressure medications, not other factors.

Understanding how blood pressure medications affect bone health is important because many older adults take these drugs, and bone health becomes increasingly important with age. If one type of blood pressure medication actually protects bones while another doesn’t, this information could help doctors choose the best medication for patients who are at risk for weak bones. This research approach is valuable because it looks at real-world data from actual patients rather than just laboratory studies.

This study has several strengths: it included a large number of participants (over 1,600), measured bone health at multiple locations, and carefully controlled for many other factors that could affect results. However, because it’s a cross-sectional study, it shows a relationship between ARBs and bone health but cannot prove that ARBs actually cause stronger bones. People taking ARBs might differ from others in ways not measured in the study. The researchers themselves noted that more research is needed to confirm these findings

What the Results Show

People taking ARBs had significantly stronger bones compared to those not taking the medication. Specifically, bone density at the hip was about 2.6% higher in ARB users, at the thighbone neck was about 2.3% higher, and at the lower spine was about 3.2% higher. These differences were statistically significant, meaning they’re unlikely to be due to chance.

The study also found that ARB users had lower levels of a bone breakdown marker called TRACP5b. This marker shows how actively bone-eating cells (called osteoclasts) are working. Lower levels suggest that bones are breaking down more slowly in people taking ARBs.

In contrast, people taking ACE inhibitors—a similar type of blood pressure medication—showed no difference in bone density or bone breakdown markers compared to those not taking the medication. This was surprising because both medications work on the same biological system (the renin-angiotensin system) that may affect bone health.

The study found that the bone-protective effect of ARBs appeared consistent across all three measurement locations (hip, thighbone neck, and spine), suggesting a widespread effect rather than something affecting just one area. The researchers also noted that the differences in bone breakdown markers were modest but statistically significant, indicating a real biological effect. The fact that ACE inhibitors showed no benefit despite being similar medications suggests that the specific way ARBs work may be important for bone health

Previous research has suggested that the renin-angiotensin system—the biological system that these blood pressure medications affect—plays a role in bone loss. This study provides some of the first human evidence that ARBs specifically may protect bones, while ACE inhibitors may not. The findings align with laboratory studies showing that ARBs can reduce the activity of bone-eating cells, but this is one of the first large studies in real patients showing this effect

The biggest limitation is that this study shows a relationship between ARBs and bone health but cannot prove that ARBs actually cause stronger bones. People taking ARBs might be different from others in ways the study didn’t measure. The study was done in Ireland, so results might not apply to other populations with different genetics or lifestyles. Additionally, the study only measured bone density at one point in time, so we don’t know if ARBs actually prevent bone loss over time or if people taking ARBs simply started with stronger bones. Finally, the study couldn’t explain exactly why ARBs might protect bones—more research is needed to understand the mechanism

The Bottom Line

If you’re already taking an ARB for blood pressure control, this research suggests your bones may be getting extra protection—which is a nice bonus. However, you should not start taking ARBs solely for bone health. Blood pressure medication decisions should be made with your doctor based on your overall health needs. If you’re concerned about bone health, focus on proven strategies: get enough calcium and vitamin D, do weight-bearing exercise, and talk to your doctor about bone health screening if you’re at risk. Confidence level: Moderate—these findings are promising but need confirmation with additional studies

This research is most relevant for older adults (60+) who take blood pressure medications or are considering them, especially those concerned about bone health. It’s also important for doctors choosing between blood pressure medications for patients at risk for weak bones. People with osteoporosis or a family history of bone problems should discuss these findings with their doctor. This research is less relevant for younger people or those not taking blood pressure medications

If ARBs do protect bones, the effect appears to develop over time as people take the medication regularly. You wouldn’t expect to see changes in bone strength in days or weeks. The people in this study had been taking ARBs for unknown lengths of time, so the protective effect likely builds up gradually over months to years of consistent use

Want to Apply This Research?

  • Track your current blood pressure medications (name and dose) and note any changes. If you have access to bone density test results (DEXA scans), log the dates and results to monitor changes over time. Set reminders to take medications consistently, as the bone benefits likely depend on regular use
  • If you take an ARB, ensure you’re taking it consistently as prescribed—the bone benefits depend on regular medication use. Additionally, combine this with bone-healthy behaviors: log calcium and vitamin D intake, track weight-bearing exercise (walking, strength training), and schedule bone density screening if recommended by your doctor
  • Create a long-term tracking system that includes: (1) medication adherence—did you take your ARB as prescribed? (2) Bone health markers—if you get DEXA scans, record the results and dates to track changes over years; (3) Lifestyle factors—calcium intake, vitamin D levels, and exercise frequency, as these also affect bone health. Review this data annually with your healthcare provider

This research shows a relationship between ARBs and stronger bones but does not prove that ARBs cause bone strengthening. Do not start, stop, or change any blood pressure medication based on this information. Blood pressure control is critical for your health, and medication decisions should always be made with your doctor based on your individual health needs. This study was observational and cannot establish cause-and-effect. If you’re concerned about bone health, discuss screening and prevention strategies with your healthcare provider. This information is for educational purposes only and should not replace professional medical advice