Antiresorptive Medication Use Is not Associated With Acute Cardiovascular Risk: An Observational Study

Author:

Bliuc Dana12ORCID,Tran Thach13ORCID,Chen Weiwen1,Alarkawi Dunia13ORCID,Alajlouni Dima A13ORCID,Blyth Fiona4,March Lyn5,Blank Robert D1ORCID,Center Jacqueline R13ORCID

Affiliation:

1. Skeletal diseases Program, Garvan Institute of Medical Research , Sydney, NSW 2010 , Australia

2. School of Population Health, Faculty of Medicine and Health , UNSW Sydney, NSW 2052 , Australia

3. School of Clinical Medicine, Faculty of Medicine and Health , UNSW Sydney, NSW 2052 , Australia

4. Concord Clinical School, University of Sydney , Sydney, NSW 2006 , Australia

5. Institute of Bone and Joint Research, University of Sydney , Sydney, NSW 2006 , Australia

Abstract

Abstract Context Bisphosphonates have been reported to be cardioprotective in some, but not all, studies. It is unknown whether denosumab (Dmab) use protects against cardiovascular events (CVEs). Objective To determine whether oral bisphosphonate (oBP) or Dmab use is associated with CVEs in persons with incident fracture. Methods Participants with an incident minimal trauma fracture from the Sax Institute’s 45 and Up Study, a population-based cohort from NSW, Australia, were followed between 2005/2009 and 2017. Questionnaire data were linked to hospital admissions (Admitted Patients Data Collection [APDC]) by the Centre for Health Record Linkage). Medicare Benefit Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data sets were provided by Services Australia. Data was stored in a secure computing environment (Secure Unified Research Environment). Fractures, CVEs, and comorbidities were identified from the APDC and oBP and Dmab medication from the PBS. oBP and Dmab users were matched to never users (NoRx) by propensity scores. The main outcome measures were association between oBP and Dmab with CVE (acute myocardial infarction, unstable angina, cerebrovascular accident, and transient ischemic attack) and were determined using a stratified Cox's proportional hazards model. Results There were 880 pairs of oBP and NoRx (616 women) and 770 pairs of Dmab and NoRx (615 women) followed for ∼4.3 years. CVE risk was similar for oBP and NoRx Hazard Ratios (HR) women, 0.88 [95% CI 0.65-1.18]; men, 1.07 [95% CI 0.72-1.57]). Similar findings were obtained for Dmab (Hazard Ratios (HR) women, 1.08 [95% CI 0.78-1.50]; men, 1.55 [95% CI 0.96-2.48]). Conclusion oBP and Dmab use was not associated with CVEs.

Funder

ISS Amgen

Publisher

The Endocrine Society

Subject

Biochemistry (medical),Clinical Biochemistry,Endocrinology,Biochemistry,Endocrinology, Diabetes and Metabolism

Reference33 articles.

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4. Association of osteoporosis medication use after hip fracture with prevention of subsequent nonvertebral fractures: an instrumental variable analysis;Desai;JAMA Netw Open,2018

5. Antiresorptive therapy and risk of mortality and refracture in osteoporosis-related hip fracture: a nationwide study;Brozek;Osteoporosis Int,2016

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