Risk of glaucoma with bisphosphonate use in patients with osteoporosis: a case-control study

Bisphosphonates (BPs) are first line agents commonly used in the management of osteoporosis. There have been two case reports that have suggested a possible link between BPs and acute angle closure (AAC). In the absence of any large epidemiologic studies, we sought to determine the risk of AAC and OAG with bisphosphonate use in patients with osteoporosis.

This was a retrospective cohort study with a case control analysis from 2008-2018. The study used the PharMetrics Plus Database (IQVIA, USA) which captures health claims for over 150 million unique patients, with fully adjudicated pharmacy and medical claims, and represents all geographic areas of the United States. 208,111 patients with osteoporosis were included in the study. AAC and OAG cases were defined by an ICD-9/10 code and had to have at least one prescription for bisphosphonate every 3 months in the year prior to the index date. The date of the first event of AAC was designated as the index date.

Bisphosphonate users were more likely to develop AAC than non-users (adjusted IRR = 1.78, 95%CI [1.05-3.01]). In particular, those on risedronate were more likely to develop AAC compared to patients who used other formulations of bisphosphonates (adjusted IRRs = 2.12, 95%CI [1.05-3.01]). There was no risk for OAG with bisphosphonate use.

Patients with osteoporosis who used BPs were at a higher risk for AAC compared to those who did not, and those who were on risedronate were more likely to develop AAC compared to patients who used other types of bisphosphonates.