Bisphosphonates: Risks of AFib and Stroke

Abhishek Sharma, M.B.B.S. Maimonides Medical Center in Brooklyn, Interview with:
Abhishek Sharma, M.B.B.S.
Maimonides Medical Center in Brooklyn, N.Y. What are the main findings of the study?

Answer:  Evidence from RCT’s and observational studies suggests a significantly increased risk of atrial fibrillation (AF) requiring hospitalization, but no increase in risk of stroke or cardiovascular mortality with the use of bisphosphonate. What should clinicians and patients take away from your report?

Answer: Considering the documented benefits of bisphosphonates to improve bone density and reducing the risk of fracture and morbidity, we recommend that the decision of using bisphosphonate therapy for long term should be individualized and associated cardiovascular risk factors should be taken into consideration while considering long term bisphosphonate therapy. What recommendations do you have for future research as a result of this study?

Answer:  One of the major limitations of the present study is that the included randomized trials (RCT) were not specifically designed to study the cardiovascular outcomes of bisphosphonates and outcomes reported in present study were not primary or secondary endpoints of RCTs included in the analyses. Thus, there could be differential surveillance or reporting in the studies, which were conducted after initial reports that bisphosphonates might cause AF. Hence, it is possible that events were underreported or misclassified.  Hence, prospective randomized data with various adverse cardiovascular outcomes as predefined endpoints is needed to further establish the possibility of an increased risk of cardiovascular events with bisphosphonate use.


Risk of Serious Atrial Fibrillation and Stroke With Use of Bisphosphonates: Evidence From a Meta-analysis.

Sharma A, Chatterjee S, Arbab-Zadeh A, Goyal S, Lichstein E, Ghosh J, Aikat S.Chest. 2013 Oct 1;144(4):1311-1322.

Last Updated on October 14, 2013 by Marie Benz MD FAAD