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Atrial fibrillation in fracture patients treated with oral bisphosphonates.
J Intern Med. 2009 May; 265(5):581-92.JI

Abstract

OBJECTIVES

To determine if patients receiving oral bisphosphonates are at excess risk of atrial fibrillation (AF), stroke and myocardial infarction.

DESIGN

Register-based restricted cohort study.

SETTING

National Hospital Discharge Register and National Prescriptions Database (1995-2005).

SUBJECTS

Fracture patients beginning bisphosphonates (n = 15 795) were matched with unexposed fracture patients of the same age, sex and fracture type (n = 31 590).

RESULTS

Incidence rates of AF were 16.5/1000 person years in untreated fracture patients and 20.6/1000 person years in bisphosphonate users. An age- and sex-adjusted hazard ratio (HR) of 1.29 (1.17-1.41) was found for probable AF by Cox proportional hazards analysis. The effect size was reduced to HR of 1.18 (1.08-1.29) by adjustment for co-medications and comorbidity. Selective prescribing was suggested by the observation that (i) risks were increased even in patients who stopped therapy after the first packet and (ii) risks were not increased by high adherence. Bisphosphonate-exposed patients were at increased risk of hospital-treated AF [adjusted HR: 1.13 (1.01-1.26)], but the risk amongst bisphosphonate users was inversely proportional to adherence. There was no increased risk of ischaemic stroke and an increased risk of myocardial infarction was not significant after adjustment for comorbidity.

CONCLUSIONS

The increased occurrence of AF in fracture patients who are users of oral bisphosphonates should be attributed to targeting of bisphosphonates to patients who are already at increased risk of cardiovascular events.

Authors+Show Affiliations

Department of Internal Medicine and Endocrinology, Copenhagen University Hospital, Gentofte, Denmark. b.abrahamsen@physician.dkNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19141097

Citation

Abrahamsen, B, et al. "Atrial Fibrillation in Fracture Patients Treated With Oral Bisphosphonates." Journal of Internal Medicine, vol. 265, no. 5, 2009, pp. 581-92.
Abrahamsen B, Eiken P, Brixen K. Atrial fibrillation in fracture patients treated with oral bisphosphonates. J Intern Med. 2009;265(5):581-92.
Abrahamsen, B., Eiken, P., & Brixen, K. (2009). Atrial fibrillation in fracture patients treated with oral bisphosphonates. Journal of Internal Medicine, 265(5), 581-92. https://doi.org/10.1111/j.1365-2796.2008.02065.x
Abrahamsen B, Eiken P, Brixen K. Atrial Fibrillation in Fracture Patients Treated With Oral Bisphosphonates. J Intern Med. 2009;265(5):581-92. PubMed PMID: 19141097.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atrial fibrillation in fracture patients treated with oral bisphosphonates. AU - Abrahamsen,B, AU - Eiken,P, AU - Brixen,K, Y1 - 2009/01/06/ PY - 2009/1/15/entrez PY - 2009/1/15/pubmed PY - 2009/5/23/medline SP - 581 EP - 92 JF - Journal of internal medicine JO - J Intern Med VL - 265 IS - 5 N2 - OBJECTIVES: To determine if patients receiving oral bisphosphonates are at excess risk of atrial fibrillation (AF), stroke and myocardial infarction. DESIGN: Register-based restricted cohort study. SETTING: National Hospital Discharge Register and National Prescriptions Database (1995-2005). SUBJECTS: Fracture patients beginning bisphosphonates (n = 15 795) were matched with unexposed fracture patients of the same age, sex and fracture type (n = 31 590). RESULTS: Incidence rates of AF were 16.5/1000 person years in untreated fracture patients and 20.6/1000 person years in bisphosphonate users. An age- and sex-adjusted hazard ratio (HR) of 1.29 (1.17-1.41) was found for probable AF by Cox proportional hazards analysis. The effect size was reduced to HR of 1.18 (1.08-1.29) by adjustment for co-medications and comorbidity. Selective prescribing was suggested by the observation that (i) risks were increased even in patients who stopped therapy after the first packet and (ii) risks were not increased by high adherence. Bisphosphonate-exposed patients were at increased risk of hospital-treated AF [adjusted HR: 1.13 (1.01-1.26)], but the risk amongst bisphosphonate users was inversely proportional to adherence. There was no increased risk of ischaemic stroke and an increased risk of myocardial infarction was not significant after adjustment for comorbidity. CONCLUSIONS: The increased occurrence of AF in fracture patients who are users of oral bisphosphonates should be attributed to targeting of bisphosphonates to patients who are already at increased risk of cardiovascular events. SN - 1365-2796 UR - https://www.unboundmedicine.com/medline/citation/19141097/Atrial_fibrillation_in_fracture_patients_treated_with_oral_bisphosphonates_ L2 - https://doi.org/10.1111/j.1365-2796.2008.02065.x DB - PRIME DP - Unbound Medicine ER -