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The association between serious upper gastrointestinal bleeding and incident bisphosphonate use: a population-based
BMC Geriatrics
|April 23, 2013
Summary
New users of oral bisphosphonates, especially those over 80 or with a history of gastrointestinal issues, face an increased risk of upper gastrointestinal bleeding (UGIB). This risk highlights the need for careful patient selection and monitoring.
Area of Science:
- Gerontology
- Pharmacology
- Gastroenterology
Background:
- Oral bisphosphonates are widely prescribed for osteoporosis prevention and treatment.
- Serious adverse effects, including upper gastrointestinal bleeding (UGIB), are associated with bisphosphonate therapy.
- The risk of UGIB in new bisphosphonate users requires further investigation.
Purpose of the Study:
- To determine if new users of oral bisphosphonates are more likely to experience a serious UGIB within 120 days of initiating therapy.
- To identify risk factors associated with UGIB in this patient population.
Main Methods:
- A population-based nested cohort study was conducted using administrative healthcare data in British Columbia, Canada.
- Individuals aged 65 years and older with a new bisphosphonate prescription between 1991 and 2007 were included.
- Multivariate logistic regression analysis examined the association between older age and serious UGIB.
Main Results:
- Among 26,223 new bisphosphonate users, 117 experienced a serious UGIB within 120 days.
- Individuals over 80 years old were more than twice as likely to suffer UGIB (adjusted OR = 2.03).
- A history of UGIB (adjusted OR = 2.28) and proton pump inhibitor (PPI) use (adjusted OR = 2.04) were significant predictors of UGIB.
Conclusions:
- Upper gastrointestinal bleeding is a rare but serious side effect of bisphosphonate therapy, disproportionately affecting older individuals.
- Clinicians should remain aware of potential adverse events and assess patients' gastrointestinal history and concurrent medications before prescribing bisphosphonates.
- The potential for rare adverse events should not deter prescribing bisphosphonates, especially for patients with fragility fractures.
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