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Oral bisphosphonates associated with increased risk of wet AMD
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People who use oral bisphosphonates may have an increased risk of developing wet age-related macular degeneration, according to a study.
The risk of AMD increased with duration of oral bisphosphonate use.
Investigators used three study designs: disproportionality analysis, case-control study and self-controlled case series. They gathered data from the FDA Adverse Event Reporting System database and data from two patient cohorts in British Columbia.
The disproportionality analysis showed 58 cases of AMD reported with alendronate, 17 cases with ibandronate and 11 with risedronate. The reported odds ratios were 3.82 with alendronate, 2.40 with ibandronate and 2.87 with risedronate.
The case-control analysis included 6,367 patients with AMD. The adjusted odds ratios for patients with 3 years of exposure to oral bisphosphonates were 1.24 at 1 year, 1.38 at 2 years and 1.59 at 3 years.
The self-controlled case series included 193 cases of wet AMD on continuous bisphosphonate use. The risk ratios for AMD were 1.22 at 1 year and 1.87 at 5 years.
“A duration response in both the case-control study and the [self-controlled case series] demonstrates that the risk of AMD with bisphosphonate increases with long-term use,” the study authors said. “Both the [self-controlled case series] study and disproportionality analysis show an increased risk for longer exposure periods, as demonstrated by higher [rate ratios] and [reported odds ratios] in longer-exposed groups.” – by Matt Hasson
Disclosure: Mammo reports no relevant financial disclosures. See the study for a full list of all other authors’ relevant financial disclosures.
Perspective
Back to TopCarl Danzig, MD
This article addresses a very important question, namely, “Are oral bisphosphonates, a commonly prescribed medication for the prevention of osteoporosis, elevating the risk of developing AMD, particularly wet AMD, in the patients taking them?” Most of us understand that smoking and obesity increase the risk of AMD, but are unaware of other modifiable risk factors and their effect on AMD. This study brings that topic to the forefront.
It is well known that bisphosphonates have proinflammatory properties and have been linked to scleritis, uveitis and optic neuritis. Mammo and colleagues hypothesized that chronic use of bisphosphonates can increase the risk of wet AMD. The authors used three distinct designs for their observational study: disproportionality analysis, case-control study and self-controlled case series. Three commonly prescribed bisphosphonates, alendronate (Fosamax), ibandronate (Boniva) and risendronate (Actonel), were all found to increase the risk of wet AMD in the disproportionality analysis, with alendronate having the strongest association. Both the case-control study and the self-controlled case series correlated increased risk of wet AMD with increasing duration of use of oral bisphosphonates.
The question that logically follows is, “What do we tell our patients who are taking oral bisphosphonates?” This is, in fact, the first study to show this link. Is it too early for patients to cease use of these important medications based on this one study? It certainly follows that further research needs to performed on this topic. If Mammo’s conclusions are validated, then the risk of developing wet AMD needs to be further quantified, and at that time, discussion be had between the patient, the prescribing physician and the ophthalmologist.
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