ArticlesHigh blood pressure and bone-mineral loss in elderly white women: a prospective study
Introduction
Animal, clinical, and some epidemiological evidence suggests that high blood pressure is associated with abnormalities of calcium metabolism, leading to increased calcium losses, secondary activation of the paarathyroid gland, and increased movement of calcium from bone.1, 2, 3, 4, 5, 6, 7 Some of these abnormalities are seen in children and young people5, 8 and are detected throughout adult life.1, 2, 3, 4, 6, 7 If substantial calcium loss related to high blood pressure, which may be due to defect in the kidney's ability to handle calcium,9, 10 is sustained over many decades, increased movement of calcium from bone may result in higher rates of mineral loss, thereby increasing the risk of osteoporosis. Metabolic studies in hypertensive rats show that hypercalciuria and ensuing hyperparathyroidism lead to reduced growth and detectable decrease in total bone-mineral content later in life.11, 12 However, no direct evidence is available in human beings.
We investigated prospectively the relation between blood pressure and bone-mineral loss in elderly white women.
Section snippets
Study population
Full details of the prospective Study of Osteoporotic Fractures have been published elsewhere.13, 14, 15, 16, 17, 18, 19 From September, 1986, to October, 1988 (visit 1), 9704 white women aged at least 65 years were recruited for baseline assessment from population-based listings (such as voter's registration lists) in four areas of the USA: Baltimore Country, MD; Minneapolis, MN; Portland; OR; and Monongahela Valley (near Pittsburgh), PA. African-American women, women who were unable to walk
Results
Participants were generally healthy women (table 1). Few women were smokers and more than 15% were on hormone-replacement therapy. After 3–5 years of follow-up, 16–9% of women were on regular antihypertensive therapy and had a small decline in bodyweight. Mean yearly loss of femoral-neck bone mineral was just over 3 mg/cm2, equivalent to a yearly loss of 0·5%.
Absolute and relative femoral-neck bone losses were significantly associated with age (r=−0·05, p<0·01; r=−0·07, p<0·001) and baseline
Discussion
Systolic blood pressure was a significant predictor of bone-mineral loss at the femoral neck. This increased rate of bone loss is not because of differences in age, bodyweight, or weight changes with time, initial bone-mineral density, smoking, or use of hormone-replacement therapy. Furthermore, the effect was not confounded by long-term thiazide diuretic use and persisted after the exclusion of women on other antihypertensive medications at follow-up. However, the size of the effect was
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