Background/Purpose:

Bisphosphonates remain the first-line agent prescribed medication for the prevention and treatment of osteoporosis. Apart from concern about atypical fractures, another concern about risk of atrial fibrillation has been raised. However, data regarding the relation of specific types of bisphosphonate use to risk of atrial fibrillation has been conflicting, and this has been reflected in contradicting conclusions from different meta-analyses. We sought to evaluate this risk using more contemporary data in a population-based cohort in which data on use of different types of bisphosphonates were available.

Methods:

We conducted a propensity score matched cohort study based on a UK population-based general practitioner database (The Health Improvement Network (THIN) database). From Jan 1, 1998 until Dec 31, 2014, we included 107,282 women who were age 50-89 years, who were free of atrial fibrillation or atrial flutter, and with no prior use of bisphosphonate within 2 years prior to study entry. Incident bisphosphonate users were defined as women with first bisphosphonate prescription. Comparators were women without bisphosphonate use prior to the 1-year cohort accrual block, with the index date randomly assigned within the 1-year accrual block. Incident atrial fibrillation was defined using READ codes. We performed an intent to treat analysis using Cox proportional hazards model, stratified by the 1 year cohort accrual blocks.

Results:

During a median of 4.5 years of follow up, we identified 53,641 pairs of bisphosphonate initiators and PS-matched comparators, whose mean age was 70. The crude incident rate of atrial fibrillation was 8.63 per 1000 person years for bisphosphonate initiators, and 8.7 per 1000 person years for comparators, with an adjusted hazard ratio of 1.01 (95%CI: 0.95-1.08). When restricted only to the commonly used bisphosphonates alendronate, ibandronate, and risedronate, the hazard ratio comparing initiators vs. comparators was 1.05 (95%CI: 0.99-1.11). Results were similar when current vs. past bisphosphonate users were compared, and when further stratified by calendar year to account for secular trends.

Conclusion:

In this large UK general population, use of bisphosphonate was not associated with risk of atrial fibrillation.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-of-bisphosphonate-and-risk-of-incident-atrial-fibrillation-in-a-population-based-study/