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Oral bisphosphonates and risk of ischemic stroke: a case-control study.
Osteoporos Int. 2011 Jun; 22(6):1773-9.OI

Abstract

Bisphosphonates have been associated with an increased risk of atrial fibrillation and may thus be associated with an increased risk of ischemic stroke. This would have substantial clinical and public health implications. We found no evidence of an association between bisphosphonate use and risk of ischemic stroke.

INTRODUCTION

Bisphosphonates have been associated with an increased risk of atrial fibrillation in some studies and may be associated with an increased risk of ischemic stroke. However, data regarding these possibilities are limited.

METHODS

We conducted a population-based case-control study of 6,257 female cases of ischemic stroke and 31,285 age- and gender-matched population controls. Data on bisphosphonate use, other medication use, comorbidity, and ischemic stroke were obtained from medical databases. Current bisphosphonate use was defined as at least one redeemed prescription within 90 days before diagnosis/index date. We estimated the odds ratio (OR) of ischemic stroke among users and nonusers of bisphosphonates using conditional logistic regression, controlling for potential confounding factors.

RESULTS

One hundred eighty-two (2.9%) cases and 901 (2.9%) controls were current users of bisphosphonates. Etidronate and alendronate were prescribed with similar frequency among cases and controls. The adjusted OR of ischemic stroke for bisphosphonate users compared with nonusers was 0.97 (95% confidence interval [CI], 0.82-1.15). New and continuing bisphosphonate users had adjusted ORs for ischemic stroke of 1.16 (95% CI, 0.69-1.96) and 0.97 (95% CI, 0.81-1.16), respectively. Excluding patients with known atrial fibrillation/flutter yielded an OR of 1.00 (95% CI, 0.85-1.19). The OR for ischemic stroke was 0.59 (95% CI, 0.32-1.09) among patients with a history of previous hospitalization for cardiovascular disease and 1.07 (95% CI, 0.88-1.18) among those without (P < 0.001). The OR for former users was 1.23 (95% CI, 1.01-1.49).

CONCLUSION

We found no evidence of an association of oral bisphosphonate use with the risk of ischemic stroke.

Authors+Show Affiliations

Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8240 Aarhus N, Denmark. sc@dce.au.dkNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

20945149

Citation

Christensen, S, et al. "Oral Bisphosphonates and Risk of Ischemic Stroke: a Case-control Study." Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, vol. 22, no. 6, 2011, pp. 1773-9.
Christensen S, Mehnert F, Chapurlat RD, et al. Oral bisphosphonates and risk of ischemic stroke: a case-control study. Osteoporos Int. 2011;22(6):1773-9.
Christensen, S., Mehnert, F., Chapurlat, R. D., Baron, J. A., & Sørensen, H. T. (2011). Oral bisphosphonates and risk of ischemic stroke: a case-control study. Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 22(6), 1773-9. https://doi.org/10.1007/s00198-010-1395-y
Christensen S, et al. Oral Bisphosphonates and Risk of Ischemic Stroke: a Case-control Study. Osteoporos Int. 2011;22(6):1773-9. PubMed PMID: 20945149.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oral bisphosphonates and risk of ischemic stroke: a case-control study. AU - Christensen,S, AU - Mehnert,F, AU - Chapurlat,R D, AU - Baron,J A, AU - Sørensen,H T, Y1 - 2010/10/13/ PY - 2010/02/09/received PY - 2010/08/30/accepted PY - 2010/10/15/entrez PY - 2010/10/15/pubmed PY - 2012/2/24/medline SP - 1773 EP - 9 JF - Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA JO - Osteoporos Int VL - 22 IS - 6 N2 - UNLABELLED: Bisphosphonates have been associated with an increased risk of atrial fibrillation and may thus be associated with an increased risk of ischemic stroke. This would have substantial clinical and public health implications. We found no evidence of an association between bisphosphonate use and risk of ischemic stroke. INTRODUCTION: Bisphosphonates have been associated with an increased risk of atrial fibrillation in some studies and may be associated with an increased risk of ischemic stroke. However, data regarding these possibilities are limited. METHODS: We conducted a population-based case-control study of 6,257 female cases of ischemic stroke and 31,285 age- and gender-matched population controls. Data on bisphosphonate use, other medication use, comorbidity, and ischemic stroke were obtained from medical databases. Current bisphosphonate use was defined as at least one redeemed prescription within 90 days before diagnosis/index date. We estimated the odds ratio (OR) of ischemic stroke among users and nonusers of bisphosphonates using conditional logistic regression, controlling for potential confounding factors. RESULTS: One hundred eighty-two (2.9%) cases and 901 (2.9%) controls were current users of bisphosphonates. Etidronate and alendronate were prescribed with similar frequency among cases and controls. The adjusted OR of ischemic stroke for bisphosphonate users compared with nonusers was 0.97 (95% confidence interval [CI], 0.82-1.15). New and continuing bisphosphonate users had adjusted ORs for ischemic stroke of 1.16 (95% CI, 0.69-1.96) and 0.97 (95% CI, 0.81-1.16), respectively. Excluding patients with known atrial fibrillation/flutter yielded an OR of 1.00 (95% CI, 0.85-1.19). The OR for ischemic stroke was 0.59 (95% CI, 0.32-1.09) among patients with a history of previous hospitalization for cardiovascular disease and 1.07 (95% CI, 0.88-1.18) among those without (P < 0.001). The OR for former users was 1.23 (95% CI, 1.01-1.49). CONCLUSION: We found no evidence of an association of oral bisphosphonate use with the risk of ischemic stroke. SN - 1433-2965 UR - https://www.unboundmedicine.com/medline/citation/20945149/Oral_bisphosphonates_and_risk_of_ischemic_stroke:_a_case_control_study_ L2 - https://doi.org/10.1007/s00198-010-1395-y DB - PRIME DP - Unbound Medicine ER -