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Bisphosphonate use may protect against colorectal cancer
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Patients who used bisphosphonates were at a slightly but significantly reduced risk for developing colorectal cancer compared with nonusers in a recent study.
Researchers performed a meta-analysis of six population-based, observational studies of 392,106 patients, including 20,001 cases of colorectal cancer (CRC), in which bisphosphonate usage was assessed and CRC outcomes were indicated. The research included two cohort and four nested case-control studies conducted between 1995 and 2009.
“Identification of more effective, tolerable and affordable agents for CRC chemoprevention is highly desirable,” the researchers wrote. “Aspirin, [NSAIDs], hormone replacement therapy and statins may have some potential chemopreventive effects in patients at high risk for CRC, but they also may induce clinically important adverse effects.”
Across all studies, 47,505 patients had been exposed to bisphosphonates. A 17% reduction in CRC incidence was associated with the use of bisphosphonates (OR=0.83; 95% CI, 0.76-0.9), although investigators noted near-significant heterogeneity across the studies (I2=37%; P=.16). This protective effect was present for rectal cancer (adjusted OR=0.66; 95% CI, 0.52-0.84) and both distal (aOR=0.65; 95% CI, 0.42-0.99) and proximal (aOR=0.67; 95% CI, 0.58-0.78) colon cancers in two studies each.
Adjustment for confounders did not significantly alter the observed association (OR=0.85; 95% CI, 0.74-0.98), but significant heterogeneity was met (I2=67%, P=.01). Using this estimated 15% risk reduction, researchers calculated that 2,698 patients would need to receive bisphosphonates for longer than 1 year to prevent one CRC case annually.
Restricting analysis to include only female patients in five studies resulted in a 16% CRC incidence reduction (OR=0.84; 95% CI, 0.70-1.01) of borderline significance. Heterogeneity also was observed (I2=74%; P=.01). Duration of bisphosphonate use indicated no difference between short-, medium- and long-term use.
“Our study suggests that bisphosphonates are associated with a statistically significant CRC risk reduction, particularly in postmenopausal women,” the researchers wrote. “However, these results should be interpreted with caution, given the possibility of residual confounding and healthy user effect. Future randomized clinical trials or prospective cohort studies in populations at high risk for CRC are needed to extend our novel findings.”
Disclosure: See the study for a full list of relevant disclosures.
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