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Saving bones without risking brain—bisphosphonates and risk of stroke: matched case-control study

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Abstract

Summary

We investigated the association between bisphosphonate treatment and the risk of stroke using a large routine clinical dataset. We found no association between bisphosphonate treatment and risk of stroke, after adjusting for large number of clinical and demographic confounders.

Introduction

There is conflicting evidence on the link between bisphosphonates and stroke with studies variously showing increased, decreased or unchanged risk. We investigated the association between bisphosphonate treatment and the risk of stroke using a large routine clinical dataset.

Methods

We used a matched nested case-control study design analysing routinely collected electronic data from patients registered at primary care practices in England participating in the Royal College of General Practitioners Research and Surveillance Centre. Cases were patients aged 18 years or over, either living or dead, recorded as having had a stroke in the period 1 January 2005 to 31 March 2016. Each case was matched to one control according to age, sex, general practice attended and calendar time. Data were analysed using Stata, version 14.2. and RStudio, version 1.1.463. Conditional logistic regression was used to determine odds ratios for stroke according to bisphosphonate treatment and duration in cases compared with controls. We adjusted for disease risk groups, cardiovascular risk factors, treatments, smoking status, alcohol consumption, ethnicity, bisphosphonate types, fracture and socioeconomic status using IMD (Index of Multiple Deprivation).

Results

We included 31,414 cases of stroke with an equal number of matched controls. Overall, 83.2% of cases and controls were aged 65 years or older, and there were similar proportions of females (51.5%) and males (48.5%). Bisphosphonate treatment was not associated with stroke after adjusting for the wide range of confounders considered (OR 0.86, 95% CI 0.62–1.19).

Conclusions

We found no association between bisphosphonate treatment and risk of stroke, after adjusting for other confounders.

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Funding

The authors declare no competing financial interests.

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Authors and Affiliations

  1. Mathematical Modelling and Statistics, Community and Health Research Unit, School of Health and Social Care, College of Social Science, University of Lincoln, Brayford Campus, Lincoln, LN6 7TS, UK

    Z. B. Asghar

  2. Community and Health Research Unit, School of Health and Social Care, College of Social Science, University of Lincoln, Brayford Campus, Lincoln, LN6 7TS, UK

    A. Godoy Caballero

  3. Section of Clinical Medicine and Ageing, Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Surrey, GU2 7XH, UK

    S. Pathirannehelage & J. Williams

  4. School of Social and Political Sciences, College of Social Science, School of Social Policy, CSS, University of Lincoln, Brayford Campus, Lincoln, LN6 7TS, UK

    S. McKay

  5. School of Pharmacy, College of Science, University of Lincoln, Brayford Campus, Lincoln, LN6 7TS, UK

    P. Grassby

  6. Primary Care and Clinical Informatics, Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK

    S. de Lusignan

  7. Primary & Pre-Hospital Health Care, Community and Health Research Unit, School of Health and Social Care, College of Social Science, University of Lincoln, Brayford Campus, Lincoln, LN6 7TS, UK

    A. Niroshan Siriwardena

Authors
  1. Z. B. Asghar
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  2. A. Godoy Caballero
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  3. S. Pathirannehelage
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  4. J. Williams
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  5. S. McKay
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  6. P. Grassby
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  7. S. de Lusignan
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  8. A. Niroshan Siriwardena
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Correspondence to Z. B. Asghar.

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Asghar, Z., Godoy Caballero, A., Pathirannehelage, S. et al. Saving bones without risking brain—bisphosphonates and risk of stroke: matched case-control study. Osteoporos Int 30, 1845–1854 (2019). https://doi.org/10.1007/s00198-019-05045-z

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  • DOI: https://doi.org/10.1007/s00198-019-05045-z

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