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Got It, Hide thisSharma A, Chatterjee S, Arbab-Zadeh A, et al. Risk of serious atrial fibrillation and stroke with use of bisphosphonates: evidence from a meta-analysis. Chest. 2013;144:1311-22.
Are bisphosphonates associated with serious atrial fibrillation, stroke, or cardiovascular death?
Osteoporosis is a condition that causes the bones to become weak or brittle and more likely to break if a person falls. Older people and women who have reached menopause are at greater risk of osteoporosis. Bisphosphonates are a type of drug used to increase bone strength and prevent bone fractures (or breaks) in people with osteoporosis. There is some concern that bisphosphonates may increase the risk of atrial fibrillation, stroke, or death due to cardiovascular causes.
The researchers did a systematic review, searching for studies published up to April 2012. They found 12 studies, including 6 randomized controlled trials with 41,375 people (average age 67 to 75 years).
Key features of the 6 randomized controlled trials were:
All 6 randomized trials were rated as good quality.
Compared with placebo or low-dose ibandronate, bisphosphonates:
Bisphosphonates increase risk of serious atrial fibrillation by a small amount. They do not increase risks of stroke or death due to cardiovascular causes.
Outcomes | Number of trials (people) | Rate of events with bisphosphonates | Rate of events with placebo or low-dose ibandronate | Absolute effect of bisphosphonates at 2 to 6 years |
Serious atrial fibrillation | 6 trials (41,375) | 0.79% (less than 1%) | 0.66% (less than 1%) | 13 more people out of 10,000 had serious atrial fibrillation |
Stroke | 4 trials (26,159) | 1.6% | 1.7% | No difference† |
Death due to cardiovascular causes | 4 trials (26,159) | 1.9% | 2.0% | No difference† |
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