Cardiovascular Events Among Female Users of Osteoporosis Treatments: A Cohort Study in United Kingdom Primary Care Data.
- 1Department of Epidemiology, Boston Collaborative Drug Surveillance Program, Lexington, MA, USA.
- 2Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
Abstract
Background
Information on cardiovascular disease (CVD) safety of osteoporosis treatments is important for patients and clinicians choosing between treatment options.Methods
We conducted a cohort study in the United Kingdom Clinical Practice Research Datalink Aurum and linked inpatient data (2000-2020). We selected two cohorts of female patients aged 40-89 with no history of CVD: (1) treated cohort: new users of study drugs (alendronate, ibandronate, risedronate, zoledronic acid, etidronate, denosumab, raloxifene, teriparatide, and calcitonin); (2) common reference cohort: prescription vitamin D users with a diagnosis or monitoring for osteoporotic disease. We followed patients from first prescription through censor date (event, major comorbidity, age 90, or end of record) and estimated adjusted incidence rate ratios (aIRRs) of atrial fibrillation (AFib), myocardial infarction (MI), stroke, and fatal stroke, by study drug compared to vitamin D-only. We assessed aIRRs compared to the common referent across all osteoporosis treatments.Results
Among 226,484 (74%) patients in the treated cohort and 79,973 (26%) in the vitamin D-only referent cohort, there were 4313 AFib, 7312 stroke, and 3846 MI outcomes. AFib rates were highest in zoledronic acid users (13 outcomes; aIRR 1.87; 95% CI 1.08-3.24). MI incidence was highest among ibandronate users (63 outcomes; aIRR 1.50; 95% CI 1.16-1.95). There were no differences in rates of AFib or MI across other study drugs or for stroke or fatal stroke for any study drug.Conclusion
Rates of AFib, MI and stroke were similar across most osteoporosis treatments, including between various types of bisphosphonates. However, the rate of AFib was increased among zoledronic acid users and rate of MI was somewhat increased among ibandronate users. However, findings were generally limited by small numbers of exposed outcomes.
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BibTeX
@article{persson2026cardiovascular,
title = {{Cardiovascular Events Among Female Users of Osteoporosis Treatments: A Cohort Study in United Kingdom Primary Care Data.}},
author = {Rebecca Persson and Tzu-Hsuan Yang and Zarena Jafry and Catherine Vasilakis-Scaramozza and Katrina Wilcox Hagberg and Susan S Jick},
journal = {Clinical epidemiology},
year = {2026},
month = oct,
doi = {10.2147/clep.s635893},
url = {https://europepmc.org/article/MED/42974095},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Cardiovascular Events Among Female Users of Osteoporosis Treatments: A Cohort Study in United Kingdom Primary Care Data.
AU - Rebecca Persson
AU - Tzu-Hsuan Yang
AU - Zarena Jafry
AU - Catherine Vasilakis-Scaramozza
AU - Katrina Wilcox Hagberg
AU - Susan S Jick
PY - 2026
DA - 2026/10/29
JO - Clinical epidemiology
DO - 10.2147/clep.s635893
UR - https://europepmc.org/article/MED/42974095
AB - Background Information on cardiovascular disease (CVD) safety of osteoporosis treatments is important for patients and clinicians choosing between treatment options.Methods We conducted a cohort study in the United Kingdom Clinical Practice Research Datalink Aurum and linked inpatient data (2000-2020). We selected two cohorts of female patients aged 40-89 with no history of CVD: (1) treated cohort: new users of study drugs (alendronate, ibandronate, risedronate, zoledronic acid, etidronate, denosumab, raloxifene, teriparatide, and calcitonin); (2) common reference cohort: prescription vitamin D users with a diagnosis or monitoring for osteoporotic disease. We followed patients from first prescription through censor date (event, major comorbidity, age 90, or end of record) and estimated adjusted incidence rate ratios (aIRRs) of atrial fibrillation (AFib), myocardial infarction (MI), stroke, and fatal stroke, by study drug compared to vitamin D-only. We assessed aIRRs compared to the common referent across all osteoporosis treatments.Results Among 226,484 (74%) patients in the treated cohort and 79,973 (26%) in the vitamin D-only referent cohort, there were 4313 AFib, 7312 stroke, and 3846 MI outcomes. AFib rates were highest in zoledronic acid users (13 outcomes; aIRR 1.87; 95% CI 1.08-3.24). MI incidence was highest among ibandronate users (63 outcomes; aIRR 1.50; 95% CI 1.16-1.95). There were no differences in rates of AFib or MI across other study drugs or for stroke or fatal stroke for any study drug.Conclusion Rates of AFib, MI and stroke were similar across most osteoporosis treatments, including between various types of bisphosphonates. However, the rate of AFib was increased among zoledronic acid users and rate of MI was somewhat increased among ibandronate users. However, findings were generally limited by small numbers of exposed outcomes.
SN - 1179-1349
ER -