Osteoporosis International

, Volume 23, Issue 1, pp 247–254

Use of bisphosphonate and risk of atrial fibrillation in older women with osteoporosis

  • C. W. Rhee
  • J. Lee
  • S. Oh
  • N. K. Choi
  • B. J. Park
Original Article

DOI: 10.1007/s00198-011-1608-z

Cite this article as:
Rhee, C.W., Lee, J., Oh, S. et al. Osteoporos Int (2012) 23: 247. doi:10.1007/s00198-011-1608-z

Abstract

Summary

Concerns have been raised among clinicians and patients whether or not bisphosphonates increase the risk of atrial fibrillation. In this large cohort study, increased risk of atrial fibrillation was not found to be associated with bisphosphonate. In fact, bisphosphonate even showed a protective effect against cardiac arrhythmia compared to other osteoporosis medications.

Introduction

Increased risk of atrial fibrillation among bisphosphonate users has been reported; however, the results from these studies are controversial. The purpose of this study was to evaluate the risk of atrial fibrillation associated with bisphosphonate use in older women.

Methods

We used the Korean Health Insurance Review and Assessment Service claims database from May 1, 2005 to June 30, 2006. Retrospective cohort analysis was conducted on women 65 years or older with newly diagnosed cases of osteoporosis (ICD 10 code: M80, M81) who had not previously taken any medications for osteoporosis. Bisphosphonate-exposed and non-exposed patients were followed until they were either diagnosed with atrial fibrillation (ICD 10 code: I48) or until the end of the study. The Cox proportional hazards model was used to calculate hazard ratios and the 95% confidence intervals.

Results

Atrial fibrillation was reported in 626 of the 120,319 patients (0.52%) treated with bisphosphonates and 66 of 9,863 patients (0.67%) treated with other osteoporosis medications. Overall hazard ratio for developing atrial fibrillation in the bisphosphonate-treated group was 0.52 (95% CIs, 0.29–0.91). In patients with a medication possession ratio greater than 0.7, the hazard ratio was lower (HR 0.41, 95% CIs 0.23–0.75). In the subgroup analysis, alendronate showed a statistically significant protective effect against the risk of atrial fibrillation with a hazard ratio of 0.75 (95% CI, 0.58–0.97).

Conclusion

Among older Korean women with osteoporosis, bisphosphonate was found to have a protective effect against atrial fibrillation.

Keywords

Atrial fibrillation Bisphosphonate Cohort Osteoporosis Pharmacoepidemiology 

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • C. W. Rhee
    • 1
  • J. Lee
    • 2
  • S. Oh
    • 3
  • N. K. Choi
    • 1
    • 4
  • B. J. Park
    • 1
    • 2
  1. 1.Department of Preventive MedicineSeoul National University College of MedicineSeoulSouth Korea
  2. 2.Medical Research Collaborating CenterSeoul National University HospitalSeoulSouth Korea
  3. 3.Department of Internal MedicineSeoul National University College of MedicineSeoulSouth Korea
  4. 4.Medical Research CenterSeoul National UniversitySeoulSouth Korea

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