Anti-resorptive medication use is not associated with acute cardiovascular risk: An observational study: Anti-resorptive medication and cardiovascular risk.

BACKGROUND: Bisphosphonates have been reported to be cardio-protective in some, but not all studies. It is unknown whether denosumab use protects against cardiovascular events (CVE).

OBJECTIVES: To determine whether oral bisphosphonate (oBP) or denosumab (Dmab) use is associated with CVE in persons with incident fracture.

DESIGN: 267,357 participants from The Sax's Institute 45 and Up Study followed (2005/2009 - 2017). Questionnaire data were linked to hospital admissions (Admitted Patients Data Collection -APDC),1 Pharmaceutical Benefits Scheme (PBS)2 and stored securely3. Fractures, CVEs and comorbidities were identified from APDC and medication from PBS.

SETTING: Population-based cohort from NSW, Australia.

PARTICIPANTS: Individuals aged 45 + with an incident fracture. oBP and Dmab users were matched to NoRx by propensity scores.

MAIN OUTCOME MEASUREMENTS: Association between oBP and Dmab with CVE (acute myocardial infarction, unstable angina, cerebro-vascular accident and transient ischaemic attack) was determined using a stratified Cox's proportional hazards model.

RESULTS: There were 880 pairs of oBP and noRx (616 women) and 770 pairs of Dmab and NoRx (615 women) followed for ∼4.3 years. CVE risk was similar for oBP and NoRx [women: HR 0.88 (95% CI, 0.65-1.18) and men: 1.07 (95% CI, 0.72-1.57)]. Similar findings were obtained for Dmab [women: 1.08 (95% CI, 0.78-1.50) and men: 1.55 (95% CI, 0.96-2.48)].

CONCLUSIONS: oBP and Dmab use was not associated with CVE.