Role of the renin–angiotensin–aldosterone system in bone metabolism

With the acceleration of population aging, the incidence of osteoporosis has gradually increased, and osteoporosis and fractures caused by osteoporosis have gradually become a serious social public health problem. The classic role of the renin–angiotensin–aldosterone system (RAAS) is to keep blood pressure stable. However, as the components of RAAS were found in bone tissues, their functions of stimulating osteoclast formation and inhibiting osteoblast activity thus inducing bone loss have gradually emerged. RAAS blockers can prevent osteoporotic fractures which may be related to angiotensin type 1 (AT1) receptor, osteoprotegerin (OPG)/nuclear factor-κB ligand (RANKL), and angiotensin-converting enzyme 2 (ACE2)/angiotensin (1–7) (Ang (1–7))/G protein-coupled receptor (Mas) cascade. However, some studies suggest that RAAS blockers do not prevent osteoporotic fractures. This article reviews the effects of RAAS and RAAS inhibitors on bone metabolism and provides new ideas for the prevention of osteoporosis.