Comparative Effectiveness of Individual Angiotensin Receptor Blockers on Osteoporosis and Osteoporotic Fracture Risk: A Nationwide Active-Comparator New-User Cohort Study.
Wu H, Wu W, et al. • Calcified tissue international • 2026
Compared with other ARBs, telmisartan use was associated with a lower risk of osteoporosis and osteoporotic fractures in this nationwide Taiwanese cohort, suggesting clinically relevant heterogeneity within the ARB class; prospective studies are needed to confirm this.
Key Findings
Results
Telmisartan use was associated with a lower risk of the composite outcome of osteoporosis or osteoporotic fracture than other ARBs.
Adjusted HR 0.65 (95% CI 0.53-0.79).
Nationwide active-comparator new-user cohort of hypertensive patients aged 51-80 years who newly initiated telmisartan or another ARB between 2002 and 2021.
Propensity score matching at 1:4 was used to balance baseline characteristics; Cox proportional hazards models estimated aHRs.
Mean follow-up was 4.35 ± 4.12 years.
Results
Telmisartan use was associated with a lower risk of incident osteoporosis when analyzed as an individual outcome.
Adjusted HR 0.60 (95% CI 0.43-0.84).
Compared with other ARBs in the propensity-matched cohort.
Results
Telmisartan use was associated with a markedly lower risk of hip fracture than other ARBs.
Adjusted HR 0.37 (95% CI 0.19-0.70).
Analyzed as an individual outcome component of the composite.
Results
In the secondary analysis of time to first osteoporotic fracture, telmisartan use was associated with a lower fracture risk than other ARBs.
Adjusted HR 0.71 (95% CI 0.57-0.90).
Time to first osteoporotic fracture was a prespecified secondary outcome.
Conclusions
The authors conclude that clinically relevant heterogeneity may exist within the ARB class and that antihypertensive drug selection may influence skeletal outcomes beyond blood pressure control.
Telmisartan has distinctive pharmacology, including partial PPAR-γ agonistic activity, which may affect bone metabolism.
The study used Taiwan's Longitudinal Generation Tracking Database (LGTD) within the Health and Welfare Data Science Center (HWDC).
The authors state that further prospective studies are warranted to confirm the findings.
What This Means
This study used Taiwan's national health database to compare bone outcomes in people with high blood pressure who started taking telmisartan versus other drugs in the same class (angiotensin receptor blockers, or ARBs). Patients aged 51-80 were matched on baseline characteristics and followed for an average of about 4.4 years.
People taking telmisartan had a lower risk of developing osteoporosis or an osteoporotic fracture than those taking other ARBs (about 35% lower risk). Lower risks were also seen for osteoporosis alone, for hip fracture specifically, and for a first osteoporotic fracture. Telmisartan has an unusual property, partial activation of a receptor called PPAR-γ, which might affect bone, though this study did not test the mechanism.
This research suggests that drugs within the ARB class may not all affect bone health equally. Because this was an observational study, it cannot prove that telmisartan itself caused the lower risk, and the authors say prospective studies are needed to confirm the findings.
Wu H, Wu W, Tsai C, Chien W, Chou Y, Lin M, et al.. (2026). Comparative Effectiveness of Individual Angiotensin Receptor Blockers on Osteoporosis and Osteoporotic Fracture Risk: A Nationwide Active-Comparator New-User Cohort Study.. Calcified tissue international. https://doi.org/10.1007/s00223-026-01630-7