Osteoporosis drug use posts increased risk for heart problems

People who take bisphosphonates for osteoporosis may be at risk for serious atrial fibrillation, or an irregular heartbeat, according to a new study.

The research, presented at CHEST 2008, the 74th annual international scientific assembly of the American College of Chest Physicians, shows that people taking alendronate or zoledronic acid were significantly more likely to experience serious atrial fibrillation, including hospitalization or death, compared with placebo.

“Atrial fibrillation can be serious if it is persistent or occurs in people with pre-existing heart disease or hypertension,” Jennifer Miranda, MD, of Jackson Memorial Hospital in Miami, said in a press release. “If left untreated, it can lead to pulmonary edema, congestive heart failure, or the formation of a blood clot that can cause a brain embolism and stroke.”

In a meta-analysis, Miranda and colleagues from the University of Miami evaluated the relationship between the use of bisphosphonates and atrial fibrillation, a condition that can produce a wide range of symptoms, including light-headedness, palpitations, chest pain and shortness of breath, or no symptoms at all.

Three studies met eligibility criteria and included a total of 16,322 patients, of whom 76% to 100% were women using bisphosphonates for osteoporosis. The patients in the study, who had a mean age range 69 to 75 years, were taking alendronate or zoledronic acid.

The meta-analysis showed that 2.5% to 3% of patients taking bisphosphonates experienced atrial fibrillation and 1% to 2% experienced serious atrial fibrillation, including hospitalization or death. Patients taking bisphosphonates were more likely to experience the condition than patients receiving placebo and up to two times more likely to experience serious atrial fibrillation than patients receiving placebo, according to the press release.

“In patients with increased risk factors for atrial fibrillation, clinicians should be more cautious when choosing treatment for osteoporosis and weigh the risks against the benefit of decreased fracture risk,” Miranda said in the release.

“Bisphosphonates are widely used to treat millions of women and men who suffer from osteoporosis or low bone density,” added James A.L. Mathers Jr., MD, FCCP, president of the American College of Chest Physicians, in the press release. “A potential link between bisphosphonates and atrial fibrillation warrants additional research in this area.”