Beta-blocker exposure is associated with nonunion in a geriatric cohort of 253,266 fractures

Previously published animal studies have shown positive skeletal effects with local or systemic administration of beta blockers (BBs). However, population studies have shown mixed effects on bone mineral density (BMD) and fracture risk with BB use. The goal of this study was to evaluate whether exposure to BB is associated with fracture nonunion. Fee-for-service Medicare beneficiaries with an extremity fracture were identified by International Classification of Diseases (ICD)-10 and current procedural terminology (CPT) codes from 2016-2019. Charlson Comorbidity Index (CCI) was assigned using diagnoses prior to index fracture and nonunion identified by ICD-10 or CPT codes within one year from index fracture diagnosis. Patients were classified by BB exposure based on Part D (Pharmacy) claims between 90 days prior to and one year following index fracture. Chi square and Students T-tests were performed on categorical and continuous variables, respectively. Logistic regression was performed to evaluate the association between BB use and nonunion, controlling for age, sex, race, and comorbidity. Total number of fractures meeting inclusion criteria was 253,266 with 45% of patients having used a BB during the study period. The incidence of nonunion was 3.9% overall. BBs were associated with a 13% increase in non-union for all fracture types, after controlling for age, sex, fracture location, and CCI (OR 1.13 [CI 1.06-1.20], p<.001). Results of this study suggest a negative influence of BB on bone healing, contrary to results of previously published animal models and epidemiologic observations, and demonstrate that BB use during fracture care is associated with significant increase in incidence of nonunion.