Bisphosphonate, denosumab not linked to acute cardiovascular risk

Use of oral bisphosphonate or denosumab does not appear to increase the risk of cardiovascular events (CVEs), namely acute myocardial infarction, unstable angina, cerebrovascular accident, and transient ischemic attack, in persons with incident fracture, a study has shown.

Some studies have reported the cardioprotective benefits of bisphosphonates, while the those for denosumab remains relatively unknown, according to the investigators.

This observational study determined whether oral bisphosphonate or denosumab use correlated with CVEs in individuals with an incident minimal trauma fracture. Participants from the Sax Institute’s 45 and Up Study, a population-based cohort from Australia, were followed between 2005/2009 and 2017.

Questionnaire data were linked to hospital admissions (Admitted Patients Data Collection [APDC]) by the Centre for Health Record Linkage. Services Australia provided data sets for Medicare Benefit Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). Data was stored in Secure Unified Research Environment, a protected computing environment.

The investigators then identified fractures, CVEs, and comorbidities from the APDC, and oral bisphosphonate and denosumab medication from the PBS. They matched the users of these therapies to never users (NoRx) using propensity scores.

A total of 880 pairs of bisphosphonate users and NoRX (616 women) and 770 pairs of denosumab users and NoRx (615 women) were followed for about 4.3 years.

The risk of CVE was similar between users of bisphosphonates and NoRx (women: hazard ratio [HR], 0.88, 95 percent confidence interval [CI], 0.65‒1.18; men: HR, 1.07, 95 percent CI, 0.72‒1.57), as well as between denosumab users and NoRx (women: HR, 1.08, 95 percent CI, 0.78‒1.50; men: HR, 1.55, 95 percent CI, 0.96‒2.48).