title: Carpal Tunnel Syndrome Associated with Oral Bisphosphonates. A Population-Based Cohort Study.
abstract: BACKGROUND
  Bisphosphonates are widely used to prevent osteoporotic fractures. Some severe musculoskeletal reactions have been described with this medication; among them, some cases of carpal tunnel syndrome. Thus, the aim of this study was to explore whether bisphosphonates may be associated with this syndrome.
  
  
  METHODS
  A cohort study was conducted to compare exposed to unexposed women; the exposed group was that composed of women having received at least one prescription of an oral bisphosphonate. For the purpose, we used information from The Health Improvement Network (THIN) database. The outcome of interest was defined as those women diagnosed with carpal tunnel syndrome. A survival analysis was performed; the Cox proportional hazard model was used to calculate hazard ratios and 95% confidence intervals, and to adjust for identified confounding variables.
  
  
  RESULTS
  Out of a sample of 59,475 women older than 51 years, 19,825 were treated with bisphosphonates during the period studied. No differences in age distribution or mean follow-up time were observed between the two groups in comparison. Overall, there were 572 women diagnosed with carpal tunnel syndrome, 242 (1.2%) in the group exposed to bisphosphonates, and 330 (0.8%) in the unexposed. An adjusted hazard ratio of developing carpal tunnel syndrome of 1.38 (95%CI, 1.15-1.64) was found for women exposed to bisphosphonates; no significant changes in the hazard ratios were found when considering different levels of bisphosphonate exposure.
  
  
  CONCLUSIONS
  An increased risk of carpal tunnel syndrome is associated with the use of bisphosphonates in postmenopausal women.
authors.affiliation: Centro de Estudios sobre la Seguridad de los Medicamentos, Universidad de Valladolid, Valladolid, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Carvajal
authors.affiliation: Centro de Estudios sobre la Seguridad de los Medicamentos, Universidad de Valladolid, Valladolid, Spain.
authors.forename: Luis H
authors.initials: LH
authors.lastname: Martín Arias
authors.affiliation: Centro de Estudios sobre la Seguridad de los Medicamentos, Universidad de Valladolid, Valladolid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Sáinz
authors.affiliation: Centro de Estudios sobre la Seguridad de los Medicamentos, Universidad de Valladolid, Valladolid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Escudero
authors.affiliation: Centro de Estudios sobre la Seguridad de los Medicamentos, Universidad de Valladolid, Valladolid, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Fierro
authors.affiliation: AG Epidemiologie and International Public Health, Universität Bielefeld, Bielefeld, Germany.
authors.forename: Odile
authors.initials: O
authors.lastname: Sauzet
authors.affiliation: Department of Primary Care & Public Health Sciences, King's College London, London, United Kingdom.
authors.forename: Victoria R
authors.initials: VR
authors.lastname: Cornelius
authors.affiliation: Department of Primary Care & Public Health Sciences, King's College London, London, United Kingdom.
authors.forename: Mariam
authors.initials: M
authors.lastname: Molokhia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D002349:Carpal Tunnel Syndrome / Q000453:epidemiology* / Q000209:etiology*; D015331:Cohort Studies; D015897:Comorbidity; D004164:Diphosphonates / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011159:Population Surveillance; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates