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Alendronate and raloxifene use related to cardiovascular diseases: differentiation by different dosing regimens of alendronate.
Clin Ther. 2011 Sep; 33(9):1173-9.CT

Abstract

BACKGROUND

Bisphosphonates are the class of medication used most widely to treat osteoporosis. Since an article reported that patients who used zoledronic acid, a bisphosphonate, had a higher proportion of atrial fibrillation (AF) in 2007, the issue of bisphosphonates and AF has become a growing concern. Due to the widespread use of bisphosphonates, it is necessary to explore the relationship between bisphosphonates and AF and other cardiovascular diseases.

OBJECTIVE

We aimed to investigate the risk of AF, stroke, or acute myocardial infarction (AMI) associated with the use of the bisphosphonates alendronate and raloxifene in patients with osteoporosis. We also focused our analysis on the impact of different dosing regimens of alendronate.

METHODS

The National Health Insurance Research Database was used to conduct an 8-year, population-based, retrospective cohort study. The study population comprised women who first took alendronate or raloxifene between 2002 and 2006 and who had a history of osteoporosis and vertebral or spinal fracture. Follow-up was conducted for every patient until the first diagnosis of AF, stroke, or AMI or until the end of the 1-year follow-up period. The Cox proportional hazards model was used to evaluate the association between the risk of cardiovascular disease and the prescription of alendronate or raloxifene.

RESULTS

We identified 9609 women who had been prescribed either alendronate (n = 6949) or raloxifene (n = 2660). The patients treated with alendronate were at a lower risk of AF, stroke, or AMI compared with the raloxifene group (AF: hazard ratio [HR] = 0.60 [95% CI, 0.42-0.85]; stroke: HR = 0.47 [95% CI, 0.39-0.57]; AMI: HR = 0.51 [95% CI, 0.36-0.72]). However, when analyzing the groups by different alendronate dosing regimens, those patients who received alendronate 10 mg had a significantly higher risk of AF and stroke compared with patients who received raloxifene (AF: HR = 1.66 [95% CI, 1.12-2.46]; stroke: HR = 1.56 [95% CI, 1.23-1.98]). The alendronate 70-mg group demonstrated a lower risk of cardiovascular disease, be it AF, stroke, or AMI (AF: HR = 0.28 [95% CI, 0.18-0.43]; stroke: HR = 0.23 [95% CI, 0.18-0.30]; AMI: HR = 0.28 [95% CI, 0.18-0.41]). When we assigned alendronate 10 mg as the reference group, the alendronate 70 mg group had a lower risk of 3 cardiovascular diseases (AF: HR = 0.17 [95% CI, 0.10-0.27]; stroke: HR = 0.16 [95% CI, 0.12-0.22]; AMI: HR = 0.21 [95% CI, 0.13-0.35]).

CONCLUSIONS

Alendronate 10 mg was associated with a higher risk of cardiovascular disease than alendronate 70 mg. Further studies are required to investigate this relationship.

Authors+Show Affiliations

Institute of Health and Welfare Policy, College of Medicine, National Yang-Ming University, Taipei, Taiwan.No 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

21849210

Citation

Lu, Pei-Yu, et al. "Alendronate and Raloxifene Use Related to Cardiovascular Diseases: Differentiation By Different Dosing Regimens of Alendronate." Clinical Therapeutics, vol. 33, no. 9, 2011, pp. 1173-9.
Lu PY, Hsieh CF, Tsai YW, et al. Alendronate and raloxifene use related to cardiovascular diseases: differentiation by different dosing regimens of alendronate. Clin Ther. 2011;33(9):1173-9.
Lu, P. Y., Hsieh, C. F., Tsai, Y. W., & Huang, W. F. (2011). Alendronate and raloxifene use related to cardiovascular diseases: differentiation by different dosing regimens of alendronate. Clinical Therapeutics, 33(9), 1173-9. https://doi.org/10.1016/j.clinthera.2011.07.012
Lu PY, et al. Alendronate and Raloxifene Use Related to Cardiovascular Diseases: Differentiation By Different Dosing Regimens of Alendronate. Clin Ther. 2011;33(9):1173-9. PubMed PMID: 21849210.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Alendronate and raloxifene use related to cardiovascular diseases: differentiation by different dosing regimens of alendronate. AU - Lu,Pei-Yu, AU - Hsieh,Chi-Feng, AU - Tsai,Yi-Wen, AU - Huang,Weng-Foung, Y1 - 2011/08/17/ PY - 2011/07/15/accepted PY - 2011/8/19/entrez PY - 2011/8/19/pubmed PY - 2012/2/14/medline SP - 1173 EP - 9 JF - Clinical therapeutics JO - Clin Ther VL - 33 IS - 9 N2 - BACKGROUND: Bisphosphonates are the class of medication used most widely to treat osteoporosis. Since an article reported that patients who used zoledronic acid, a bisphosphonate, had a higher proportion of atrial fibrillation (AF) in 2007, the issue of bisphosphonates and AF has become a growing concern. Due to the widespread use of bisphosphonates, it is necessary to explore the relationship between bisphosphonates and AF and other cardiovascular diseases. OBJECTIVE: We aimed to investigate the risk of AF, stroke, or acute myocardial infarction (AMI) associated with the use of the bisphosphonates alendronate and raloxifene in patients with osteoporosis. We also focused our analysis on the impact of different dosing regimens of alendronate. METHODS: The National Health Insurance Research Database was used to conduct an 8-year, population-based, retrospective cohort study. The study population comprised women who first took alendronate or raloxifene between 2002 and 2006 and who had a history of osteoporosis and vertebral or spinal fracture. Follow-up was conducted for every patient until the first diagnosis of AF, stroke, or AMI or until the end of the 1-year follow-up period. The Cox proportional hazards model was used to evaluate the association between the risk of cardiovascular disease and the prescription of alendronate or raloxifene. RESULTS: We identified 9609 women who had been prescribed either alendronate (n = 6949) or raloxifene (n = 2660). The patients treated with alendronate were at a lower risk of AF, stroke, or AMI compared with the raloxifene group (AF: hazard ratio [HR] = 0.60 [95% CI, 0.42-0.85]; stroke: HR = 0.47 [95% CI, 0.39-0.57]; AMI: HR = 0.51 [95% CI, 0.36-0.72]). However, when analyzing the groups by different alendronate dosing regimens, those patients who received alendronate 10 mg had a significantly higher risk of AF and stroke compared with patients who received raloxifene (AF: HR = 1.66 [95% CI, 1.12-2.46]; stroke: HR = 1.56 [95% CI, 1.23-1.98]). The alendronate 70-mg group demonstrated a lower risk of cardiovascular disease, be it AF, stroke, or AMI (AF: HR = 0.28 [95% CI, 0.18-0.43]; stroke: HR = 0.23 [95% CI, 0.18-0.30]; AMI: HR = 0.28 [95% CI, 0.18-0.41]). When we assigned alendronate 10 mg as the reference group, the alendronate 70 mg group had a lower risk of 3 cardiovascular diseases (AF: HR = 0.17 [95% CI, 0.10-0.27]; stroke: HR = 0.16 [95% CI, 0.12-0.22]; AMI: HR = 0.21 [95% CI, 0.13-0.35]). CONCLUSIONS: Alendronate 10 mg was associated with a higher risk of cardiovascular disease than alendronate 70 mg. Further studies are required to investigate this relationship. SN - 1879-114X UR - https://www.unboundmedicine.com/medline/citation/21849210/Alendronate_and_raloxifene_use_related_to_cardiovascular_diseases:_differentiation_by_different_dosing_regimens_of_alendronate_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0149-2918(11)00504-2 DB - PRIME DP - Unbound Medicine ER -