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Risk of atrial fibrillation among bisphosphonate users: a multicenter, population-based, Italian study.

L Herrera1, I Leal, F Lapi

  • 1Department of Internal Medicine, Erasmus Medical Center University, Rotterdam, Netherlands.

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Current bisphosphonate (BP) users face a higher risk of atrial fibrillation (AF) compared to those who stopped BP therapy over a year ago. This finding highlights potential cardiovascular risks associated with ongoing bisphosphonate use.

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Area of Science:

  • Pharmacovigilance
  • Cardiovascular epidemiology
  • Bone metabolism and therapeutics

Background:

  • Bisphosphonates are crucial for preventing bone fractures.
  • The association between bisphosphonate use and atrial fibrillation (AF) risk remains controversial.
  • This study aimed to clarify the risk of AF in relation to bisphosphonate exposure.

Purpose of the Study:

  • To evaluate the association between current bisphosphonate use and the risk of developing atrial fibrillation.
  • To compare the risk of AF in current bisphosphonate users versus those who have discontinued therapy.
  • To investigate specific bisphosphonate agents, such as alendronate, in relation to AF risk.

Main Methods:

  • A nested case-control study was conducted using Italian regional databases (2003-2006).
  • New bisphosphonate users aged 55+ were followed to identify AF diagnoses.
  • Conditional logistic regression matched cases with controls to estimate odds ratios for AF risk based on bisphosphonate exposure duration.

Main Results:

  • Current bisphosphonate users exhibited an approximately twofold increased risk of AF (OR=1.78, 95% CI=1.46-2.16) compared to distant past users (discontinued >1 year).
  • Alendronate use showed a significant association with a higher AF risk (OR=1.97, 95% CI=1.59-2.43) compared to distant past use.
  • The findings suggest a dose- or duration-dependent relationship between bisphosphonate therapy and AF risk.

Conclusions:

  • Current bisphosphonate use is linked to an elevated risk of atrial fibrillation.
  • Patients who discontinued bisphosphonate therapy for over a year showed a lower risk of AF.
  • These results underscore the importance of considering cardiovascular risks, particularly AF, in patients undergoing bisphosphonate treatment.