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Published on: September 27, 2024
Bisphosphonate therapy start may transiently increase the risk of tendon rupture in patients with glucocorticoid
Julia Spoendlin1,2, Christian Meier3, Susan S Jick4
1Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
Purpose:
The effect of bisphosphonates on extra-osseous tissue is rarely investigated. We performed an exploratory analysis on the association of new bisphosphonate use and incident tendon rupture in patients with or without oral glucocorticoid co-medication.
Methods:
We conducted a matched case-control study using data from the UK-based Clinical Practice Research Datalink. Cases were patients aged 30-89 years with an incident diagnosis of Achilles or biceps tendon rupture between 1995 and 2013. We compared new oral bisphosphonate use between cases and controls with or without oral glucocorticoid co-medication, by timing (last prescription
Results:
Among 7859 cases, 246 (3.1%) were new users of bisphosphonates. Patients with glucocorticoid co-medication had an odds ratio (OR) for tendon rupture of 6.42 (95%CI 4.03-10.22) for short-term bisphosphonate use (≤4 prescriptions), which declined with increasing number of prescriptions. Among people with continuous prednisone use of 5-10 mg/day, bisphosphonate users with <9 prescriptions had an OR of 2.46 (95%CI 1.00-6.03), compared with bisphosphonate non-users. The case-crossover analysis yielded an OR of 4.46 (95%CI 2.76-7.20) for new bisphosphonate treatment in patients with glucocorticoid co-medication, and a null result in glucocorticoid non-users.
Conclusions:
New bisphosphonate treatment may transiently increase the risk of tendon rupture in oral glucocorticoid users. Further research is needed to establish causality of this yet unreported adverse drug reaction or drug-drug interaction. Copyright © 2016 John Wiley & Sons, Ltd.
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