Related Experiment Video
Updated: Jan 25, 2026
Fundus Photography as a Convenient Tool to Study Microvascular Responses to Cardiovascular Disease Risk Factors in Epidemiological Studies
Published on: October 22, 2014
Bisphosphonates and cardiovascular risk in elderly patients with previous cardiovascular disease: a population-based
Ursula Kirchmayer1, Chiara Sorge2, Janet Sultana3
1Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
Insights
Bisphosphonates (BPs) and strontium ranelate (SR) do not increase atrial fibrillation (AF) risk in elderly patients. While SR and BPs showed a slight increase in cardiovascular events (CCV), higher adherence revealed a protective effect, suggesting safe use in osteoporosis management.
Area of Science:
- Gerontology
- Pharmacology
- Cardiology
Background:
- Osteoporosis is a growing concern in aging populations, with available treatments lacking conclusive evidence on cardiovascular and cerebrovascular (CCV) event risks.
- Specifically, the association between anti-osteoporotic drugs and atrial fibrillation (AF) risk requires further investigation.
Purpose of the Study:
- To evaluate the association between bisphosphonates (BPs), strontium ranelate (SR), and other anti-osteoporosis drugs with the risk of AF and CCV events.
- The study focused on patients with pre-existing CCV conditions.
Main Methods:
- Two nested case-control studies were conducted on a cohort of patients aged 65+ discharged after a CCV event.
- Cases were patients with subsequent AF or CCV hospital admissions; controls were matched by age, sex, and follow-up time.
- Exposure measures included ever use, adherence, and recency of drug use.
Main Results:
- Neither BPs nor SR use was linked to an increased risk of AF, irrespective of adherence or recency.
- Overall BP and SR use showed a slight CCV risk increase, but higher adherence demonstrated a protective effect (OR 0.81 for BPs, OR 0.71 for SR).
Conclusions:
- Bisphosphonates (BPs) do not elevate cardiovascular risk and are suitable for elderly osteoporosis treatment.
- Patients with existing CCV conditions require careful monitoring when using these medications.
Background:
In a globally aging population, chronic conditions with a high impact on healthcare costs and quality of life, such as osteoporosis and associated fractures, are a matter of concern. For osteoporosis, several drug treatments are available, but evidence on adverse cardiovascular and cerebrovascular (CCV) events, and in particular the risk of atrial fibrillation (AF), related to anti-osteoporotic drug use is inconclusive. The objective of this study was to evaluate the association between the use of bisphosphonates (BPs), strontium ranelate (SR), and other anti-osteoporosis drugs and the risk of AF and CCV events in a large cohort of patients affected by CCV diseases.
Methods:
Based on a cohort of patients aged 65 years and over, discharged from the hospitals of five large Italian areas after a CCV event between 2008 and 2011, two nested case-control studies were conducted. Cases were patients with a subsequent hospital admission for AF or CCV; four controls for each case were randomly selected and matched by age group, sex and follow-up time. A total of three exposure measures were tested: ever use, adherence and recency of use. In the conditional logistic regression models, patients not treated with any anti-osteoporotic medication were considered as the reference category.
Results:
The initial cohort accounted for 657,246 patients. Neither BPs nor SR use was associated with an increased risk of AF regardless of the adherence and recency of use. Overall BP and SR use was associated with a slightly increased risk of CCV; however, results reversed when considering higher adherence: odds ratio (OR) 0.81, 95% confidence interval (CI) 0.71-0.92 for BPs and OR 0.71, 95% CI 0.52-0.97 for SR.
Conclusions:
BPs do not increase cardiovascular risk and can be prescribed to elderly patients for osteoporosis treatment. However, patients with pre-existing cerebrovascular/cardiovascular conditions should be carefully monitored.
Related Concept Videos
01:27Psychoneuroimmunology: Cardiovascular Disease
A key area of focus in PNI is the relationship between stress and coronary...
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
01:28Imaging Studies for Cardiovascular System V: CT
01:14Overview of the Cardiovascular System
Heart
The heart is the central pump of the cardiovascular system that circulates blood throughout the body. It comprises two atria receiving the blood and two ventricles pumping blood out of the heart. Their rhythmic contractions, called heartbeats, ensure that blood flow remains continuous.
Blood Vessels
Blood...
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...