Bisphosphonates increase the risk of abnormal heart rhythms

This study analyzed the association between the use of bisphosphonates and the risk of developing arterial fibrillation.

Osteoporosis, or a decrease in bone density (or strength), is common in postmenopausal women and even more so in cancer patients undergoing hormonal treatments or chemotherapy. Decreased bone density or mass significantly increases the risk of fractures. Bisphosphonates are drugs that decrease bone loss and help in the prevention of fractures. Bisphosphonates are commonly prescribed to treat osteoporosis, but also to women receiving hormonal cancer treatments, such as aromatase inhibitors or ovarian suppressors, in order to prevent bone loss.

However, bisphosphonate treatment is not without risk. Recent studies have suggested that bisphosphonates may increase the risk of a common arrhythmia (an irregular heart beat) called atrial fibrillation (AF). AF is known to increase the risk of strokes, especially in the elderly and in patients with additional medical conditions. The current study analyzed previous research on the connection between bisphosphonates and the risk of AF.

All of the studies included in this analysis examined bisphosphonate use (not necessarily in cancer patients) and reported complications such as AF, strokes, or death due to cardiovascular causes (conditions affecting the blood vessels or the heart).  Twelve studies were analyzed; six observational studies including 149,846 patients and six randomized controlled trials including a total of 41,375 patients. While observational studies simply follow patients receiving a certain drug and report results, randomized controlled studies directly compare patients receiving the drug to a control group given a placebo. Therefore, randomized controlled trials offer the most powerful evidence for the effect of a drug.

Analysis showed a significantly increased risk of AF among patients receiving bisphosphonates. In an analysis of observational studies the risk of AF was increased by 27% among bisphosphonate users. In an analysis of randomized controlled studies the risk of AF was increased by 40% among bisphosphonate users. Despite these findings, no significant increase in the risk of strokes or cardiovascular deaths was found.

This study concludes that bisphosphonates lead to a significant increase in the risk of developing atrial fibrillation.

Consult with your physician regarding the risks and benefits of bisphosphonates in the prevention of treatment induced bone loss.