Antiosteoporosis medications and cardiovascular disease: a population-based nationwide nested case-control study
Wen-Hsuan Tsai1, Fung-Chang Sung2,3,4, Chih-Hsin Muo2
1Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
Insights
Denosumab, teriparatide, and bisphosphonate show protective effects against cardiovascular disease (CVD) in osteoporosis patients. Hormone replacement therapy (HRT) was associated with increased CVD risks, guiding medication choices.
Area of Science:
- Osteoporosis and Cardiovascular Health
- Pharmacological Interventions
- Public Health Research
Background:
- Osteoporosis patients face a higher risk of cardiovascular disease (CVD).
- Several anti-osteoporosis medications are available, but their comparative cardiovascular safety profiles require assessment.
Purpose of the Study:
- To evaluate the cardiovascular disease (CVD) risks associated with different anti-osteoporosis medications.
- To compare the CVD risks of denosumab, bisphosphonate, teriparatide, and hormone replacement therapy (HRT) in osteoporosis patients.
Main Methods:
- A nested case-control analysis was conducted using Taiwan's National Health Insurance Research Database (2000-2016).
- The study included 28,387 patients aged 40+ with newly diagnosed osteoporosis who used anti-osteoporosis medications.
- Conditional logistic regression estimated odds ratios (ORs) for eight types of CVD among users of denosumab, bisphosphonate, teriparatide, and HRT.
Main Results:
- Denosumab users had significantly lower odds of overall CVDs (OR=0.13).
- Teriparatide (OR=0.52) and bisphosphonate (OR=0.80) users also showed reduced odds of overall CVDs.
- Hormone replacement therapy (HRT) users exhibited increased odds for coronary artery disease, peripheral artery disease, heart failure, pulmonary embolism, and deep vein thrombosis.
Conclusions:
- Denosumab, teriparatide, and bisphosphonate appear to offer protective effects against cardiovascular disease (CVD) compared to hormone therapy.
- Healthcare providers should consider the cardiovascular risks when selecting anti-osteoporosis treatments for patients.
Abstract:
Purpose: Patients with osteoporosis are at an increased risk of cardiovascular disease (CVD). Several antiosteoporosis medications have been demonstrated with the benefit of preventing osteoporosis. Our aim is to assess the CVD risks associated with antiosteoporosis medications using the National Health Insurance Research Database in Taiwan between 2000 and 2016. Methods: Among 41,102 patients of 40+ years old with newly diagnosed osteoporosis, 69.1% (N = 28,387) of patients were included in the user cohort of antiosteoporosis medicines, of whom 13, 472 developed CVD by the end of 2016, while 14,915 did not. Using the nested case-control analysis in the user cohort (88.0% women and 77.4% elderly), we applied conditional logistic regression to estimate odds ratios (ORs) of eight types of CVD for the users of denosumab, bisphosphonate, teriparatide, and hormone replacement therapy (HRT). Results: The adjusted ORs of overall CVDs were 0.13 (95% CI: 0.12-0.15) for denosumab users, 0.52 (95% CI: 0.45-0.61) for teriparatide users, and 0.80 (95% CI: 0.76-0.85) for bisphosphonate users. The HRT users were at higher odds of coronary artery and peripheral artery diseases, heart failure, pulmonary embolism, and deep vein thrombosis. Conclusion: Denosumab, teriparatide, and bisphosphonate may have more protective effects against CVD than hormone therapy. Physicians may take subsequent cardiovascular risks into account when choosing an adequate antiosteoporosis medication for patients with osteoporosis.
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