Cardiovascular Events Among Female Users of Osteoporosis Treatments: A Cohort Study in United Kingdom Primary Care Data
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Information on cardiovascular disease (CVD) safety of osteoporosis treatments is important for patients and clinicians choosing between treatment options. Methods: We conducted a cohort study in the United Kingdom Clinical Practice Research Datalink Aurum and linked inpatient data (2000-2020). We selected two cohorts of female patients aged 40-89 with no history of CVD: (1) treated cohort: new users of study drugs (alendronate, ibandronate, risedronate, zoledronic acid, etidronate, denosumab, raloxifene, teriparatide, and calcitonin); (2) common reference cohort: prescription vitamin D users with a diagnosis or monitoring for osteoporotic disease. We followed patients from first prescription through censor date (event, major comorbidity, age 90, or end of record) and estimated adjusted incidence rate ratios (aIRRs) of atrial fibrillation (AFib), myocardial infarction (MI), stroke, and fatal stroke, by study drug compared to vitamin D-only. We assessed aIRRs compared to the common referent across all osteoporosis treatments. Results: Among 226,484 (74%) patients in the treated cohort and 79,973 (26%) in the vitamin D-only referent cohort, there were 4313 AFib, 7312 stroke, and 3846 MI outcomes. AFib rates were highest in zoledronic acid users (13 outcomes; aIRR 1.87; 95% CI 1.08-3.24). MI incidence was highest among ibandronate users (63 outcomes; aIRR 1.50; 95% CI 1.16-1.95). There were no differences in rates of AFib or MI across other study drugs or for stroke or fatal stroke for any study drug. Conclusion: Rates of AFib, MI and stroke were similar across most osteoporosis treatments, including between various types of bisphosphonates. However, the rate of AFib was increased among zoledronic acid users and rate of MI was somewhat increased among ibandronate users. However, findings were generally limited by small numbers of exposed outcomes.
Source: Clinical Epidemiology
DOI: 10.2147/clep.s635893
Language: English
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,836
OpenAlex ID: W7224282833