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Atrial fibrillation and bisphosphonate therapy.
J Bone Miner Res. 2010 Jan; 25(1):2-10.JB

Abstract

Bisphosphonates are the most commonly used treatment for osteoporosis and have proven efficacy in the reduction of vertebral and nonvertebral fractures. Recently, concerns have been raised about a possible association between bisphosphonate therapy and atrial fibrillation (AF) following the report of a significant increase in risk of serious AF in women treated with zoledronic acid in the HORIZON study. Subsequent studies have produced conflicting results but have not excluded the possibility of such an association. Currently there is no direct evidence that bisphosphonates exert either acute or chronic effects on cardiac electrophysiology. Nevertheless, altered intracellular electrolyte homeostasis and proinflammatory, profibrotic, and antiangiogenic effects provide potential mechanisms by which atrial conduction could be affected in patients treated with bisphosphonates. In studies in which an increase in risk of AF has been identified, there is no evidence that this translates into increased mortality or increased risk of stroke, and the risk-benefit balance of bisphosphonate therapy in patients with osteoporosis and other forms of metabolic bone disease remains strongly positive.

Authors+Show Affiliations

Institute of Musculoskeletal Sciences, University of Oxford, Headington, Oxford OX3 7LD, United Kingdom. Michael.Pazianas@ndorms.ox.ac.ukNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

20091928

Citation

Pazianas, Michael, et al. "Atrial Fibrillation and Bisphosphonate Therapy." Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, vol. 25, no. 1, 2010, pp. 2-10.
Pazianas M, Compston J, Huang CL. Atrial fibrillation and bisphosphonate therapy. J Bone Miner Res. 2010;25(1):2-10.
Pazianas, M., Compston, J., & Huang, C. L. (2010). Atrial fibrillation and bisphosphonate therapy. Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, 25(1), 2-10. https://doi.org/10.1359/jbmr.091201
Pazianas M, Compston J, Huang CL. Atrial Fibrillation and Bisphosphonate Therapy. J Bone Miner Res. 2010;25(1):2-10. PubMed PMID: 20091928.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atrial fibrillation and bisphosphonate therapy. AU - Pazianas,Michael, AU - Compston,Juliet, AU - Huang,Christopher L-H, PY - 2010/1/22/entrez PY - 2010/1/22/pubmed PY - 2010/7/9/medline SP - 2 EP - 10 JF - Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research JO - J Bone Miner Res VL - 25 IS - 1 N2 - Bisphosphonates are the most commonly used treatment for osteoporosis and have proven efficacy in the reduction of vertebral and nonvertebral fractures. Recently, concerns have been raised about a possible association between bisphosphonate therapy and atrial fibrillation (AF) following the report of a significant increase in risk of serious AF in women treated with zoledronic acid in the HORIZON study. Subsequent studies have produced conflicting results but have not excluded the possibility of such an association. Currently there is no direct evidence that bisphosphonates exert either acute or chronic effects on cardiac electrophysiology. Nevertheless, altered intracellular electrolyte homeostasis and proinflammatory, profibrotic, and antiangiogenic effects provide potential mechanisms by which atrial conduction could be affected in patients treated with bisphosphonates. In studies in which an increase in risk of AF has been identified, there is no evidence that this translates into increased mortality or increased risk of stroke, and the risk-benefit balance of bisphosphonate therapy in patients with osteoporosis and other forms of metabolic bone disease remains strongly positive. SN - 1523-4681 UR - https://www.unboundmedicine.com/medline/citation/20091928/Atrial_fibrillation_and_bisphosphonate_therapy_ L2 - https://doi.org/10.1359/jbmr.091201 DB - PRIME DP - Unbound Medicine ER -