Atenolol for the Prevention of Osteoporosis (APO)

Inclusion criteria

• Able and willing to provide informed consent
• Postmenopausal women (FSH ≥ 16 IU/L) (no menses for at least one year)
• Aged 50-75 years

Exclusion criteria

• Clinical diagnosis of diabetes mellitus requiring insulin
• Clinically significant abnormality in any of the additional screening laboratory studies
• A1c- ≥8
• Calcium - > upper limit lab value per site
• AST- 2x upper normal limit
• FSH- < 16IU/L
• eGFR- < 45 mL/min/1.73m2 based on creatinine
• CBC- Per PI interpretation of each patient
• Presence of (documented clinical diagnosis of any of the following):

• Significant liver or renal disease
• Malignancy (current diagnosis including myeloma or melanoma)
• Radiation (the site PI will determine eligibility on a case-by-case basis)
• Malabsorption (current clinical diagnosis or actively receiving treatment)
• Hypoparathyroidism (current clinical diagnosis or actively receiving treatment)
• Hyperparathyroidism (current clinical diagnosis or actively receiving treatment)
• Acromegaly
• Cushing syndrome
• Hypopituitarism
• Severe chronic obstructive pulmonary disease
• Pheochromocytoma (current clinical diagnosis or actively receiving treatment)
• History of cardiac failure
• Ejection Fraction <35% (based on most recent EF within the last 12 months, if available)
• PR interval > 200 msec on screening ECG or known heart block
• History of bronchospastic disease with treatment (asthma, bronchitis)
• Gastric Bypass
• Parkinson's
• Rheumatoid Arthritis
• Psoriatic Arthritis
• Connective Tissue disease
• Undergoing treatment with any medications that affect bone turnover, including the following:

• adrenocorticosteroids (oral for > 3 months within the past year or year-round use of inhaled corticosteroid use)
• anticonvulsant therapy for seizures (carbamazepine, phenobarbital, or phenytoin within the previous year) pharmacological doses of: thyroid hormone (causing decline of thyroid stimulating hormone below normal, i.e. < 0.3 miU/L) bisphosphonates (within the past 3 yrs; if taken orally >1 month in past 3 years) denosumab, romosozumab, estrogen therapy (does not include creams or suppositories) or treatment with a selective estrogen receptor modulator, or teriparatide/abaloparatide (> 1 month within the past year); aromatase inhibitors (>1 month within the past year)
• Current use of digitalis glycosides
• Thiazides (< 6 months of use prior to screening)
• Current or within the past 3 months use of beta blockers
• Any recent fracture within the past 6 months prior to screening (other than fingers, toes and facial fractures, which are all acceptable)
• Bilateral hip replacements or metal in both hips
• Patients with serum 25-hydroxyvitamin D levels of < 20 ng/ml, in order to ensure vitamin D sufficiency
• Resting systolic blood pressure < 115 mm Hg, heart rate < 55 bpm (average of 3 readings after a 5-minute rest and one minute between readings with an automatic cuff)