An international team of researchers has conducted a retrospective cohort study to investigate adverse events associated with the use of alendronate in hip fracture patients and found that the drug actually lowers the risk of cardiovascular events.
Could Osteoporosis Drugs Be Heart Healthy?
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#osteoporosisSecondary#hip#cardiovascularevents
The study entitled ”Association of Alendronate and Risk of Cardiovascular Events in Patients With Hip Fracture” was published in the May 9, 2018 edition of Journal of Bone and Mineral Research.
Ching-Lung Cheung, Ph.D., assistant professor in the Department of Pharmacology and Pharmacy at the Centre for Genomic Sciences at The University of Hong Kong and co-author told OTW, “In a previous randomized clinical trial (RCT), a drug called zoledronate marginally reduced risk of cardiovascular death in patients with hip fracture, we found that the result was intriguing.”
“Given that bisphosphonates potentially reduce inflammation, cell injury, and cholesterol, we believe the finding in that particular clinical trial is important. Therefore, we used the real-world data to examine the relationship between bisphosphonate use and cardiac event in a group of patients with hip fracture.”
“Our findings are in agreement with the previous RCT showing that bisphosphonates in hip fracture patients had the additional benefit of reducing the risk of cardiovascular death. Use of bisphosphonates in patients with hip fracture is strongly recommended. Indeed, many clinical guidelines suggest initiating anti-osteoporosis drug treatment in patients with hip fracture, but the use of anti-osteoporosis drugs is still under-used (also called crisis in osteoporotic undertreatment), which could be due to patients’ awareness of the rare side effects of anti-osteoporosis drug.”
“Thus, our findings further encourage the use of bisphosphonates in patients with hip fracture, and the beneficial effect is not only limited to bone, but also for the heart.”
“In some places, orthopedic surgeons do not commonly prescribe a pharmacological agent to hip fracture patients, I think, in general, they should do it more proactively according to the international or local guideline. This is important for patients’ health and survival.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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