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Evidence Summary
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Key messages from scientific research that's ready to be acted on
Got It, Hide thisBisphosphonates increase risk of serious atrial fibrillation by a small amount
Sharma A, Chatterjee S, Arbab-Zadeh A, et al. Risk of serious atrial fibrillation and stroke with use of bisphosphonates: evidence from a meta-analysis. Chest. 2013;144:1311-22.
Review question
Are bisphosphonates associated with serious atrial fibrillation, stroke, or cardiovascular death?
Background
Osteoporosis is a condition that causes the bones to become weak or brittle and more likely to break if a person falls. Older people and women who have reached menopause are at greater risk of osteoporosis. Bisphosphonates are a type of drug used to increase bone strength and prevent bone fractures (or breaks) in people with osteoporosis. There is some concern that bisphosphonates may increase the risk of atrial fibrillation, stroke, or death due to cardiovascular causes.
How the review was done
The researchers did a systematic review, searching for studies published up to April 2012. They found 12 studies, including 6 randomized controlled trials with 41,375 people (average age 67 to 75 years).
Key features of the 6 randomized controlled trials were:
- people were men or postmenopausal women with osteoporosis, or men and women 50 years or older who had surgery for hip fracture;
- bisphosphonates included zoledronic acid (Reclast®, Zometa®), alendronate (Fosamax®), risedronate (Actonel®, Atelvia®), and ibandronate (Boniva®), and were taken by mouth (pills) or intravenously (by needle into a vein); and
- bisphosphonates were compared with placebo in 5 trials and with a low-dose bisphosphonate (ibandronate) in 1 trial.
What the researchers found
All 6 randomized trials were rated as good quality.
Compared with placebo or low-dose ibandronate, bisphosphonates:
- increased serious atrial fibrillation by about 0.13% (from 0.66% to 0.79%)
- did not increase risk of stroke; and
- did not increase risk of death due to cardiovascular causes.
Conclusions
Bisphosphonates increase risk of serious atrial fibrillation by a small amount. They do not increase risks of stroke or death due to cardiovascular causes.
Bisphosphonates vs placebo or low-dose ibandronate*
| Outcomes | Number of trials (people) | Rate of events with bisphosphonates | Rate of events with placebo or low-dose ibandronate | Absolute effect of bisphosphonates at 2 to 6 years |
| Serious atrial fibrillation | 6 trials (41,375) | 0.79% (less than 1%) | 0.66% (less than 1%) | 13 more people out of 10,000 had serious atrial fibrillation |
| Stroke | 4 trials (26,159) | 1.6% | 1.7% | No difference† |
| Death due to cardiovascular causes | 4 trials (26,159) | 1.9% | 2.0% | No difference† |
Glossary
A harmless, inactive, and simulated treatment.
Studies where people are assigned to one of the treatments purely by chance.
A comprehensive evaluation of the available research evidence on a particular topic.
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.
Death from circulatory problems.
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