title: Adverse cardiovascular effects of nitrogen-containing bisphosphonates in patients with osteoporosis: A nationwide population-based retrospective study.
abstract: BACKGROUND
  Bisphosphonates (BPs) are a class of medications used for the treatment of osteoporosis. Nitrogen-containing BPs (N-BPs) are more potent than non-nitrogenous BPs in terms of their effects on osteoporosis. We examined the effects of N-BPs on osteoporosis in patients included in a large population-based cohort study.
  
  
  METHODS
  Based on the National Health Insurance Research Database of Taiwan, we identified 1258 patients with osteoporosis who had received N-BP treatment from 2005 through 2010.
  
  
  RESULTS
  During the retrospective observation period, N-BP users had significantly higher incidence rates of hypertension, acute ischemic stroke, atrial fibrillation (Af), and congestive heart failure (CHF), and lower rates of hyperlipidemia than patients who did not use N-BPs. Overall, N-BP users had a higher incidence of cardiovascular events at the end of the follow-up period. After adjustment for age, sex, and comorbidities, the risk of developing cardiovascular events was significantly high for patients using N-BPs. Patients who received N-BP therapy also had a higher risk of Af and CHF than those who did not during the five-year follow-up period.
  
  
  CONCLUSIONS
  We provide evidence that patients with osteoporosis using N-BP therapy have an increased risk of CHF and Af. This potential risk should be weighed against the reduction in the risk of osteoporotic fractures.
authors.affiliation: Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Jen-Chun
authors.initials: JC
authors.lastname: Wang
authors.affiliation: School of Public Health, National Defense Medical Center, Taipei, Taiwan. Electronic address: chienwu@mail.ndmctsgh.edu.tw.
authors.forename: Wu-Chien
authors.initials: WC
authors.lastname: Chien
authors.affiliation: Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan.
authors.forename: Chi-Hsiang
authors.initials: CH
authors.lastname: Chung
authors.affiliation: Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Wen-I
authors.initials: WI
authors.lastname: Liao
authors.affiliation: Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,. Electronic address: tsaishihung@yahoo.com.tw.
authors.forename: Shih-Hung
authors.initials: SH
authors.lastname: Tsai
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology; D004164:Diphosphonates / Q000008:administration & dosage* / Q000009:adverse effects / Q000737:chemistry; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D009584:Nitrogen / Q000737:chemistry*; D010024:Osteoporosis / Q000188:drug therapy*; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013624:Taiwan; D016896:Treatment Outcome
chemical_list: D004164:Diphosphonates; D009584:Nitrogen
keywords: Atrial fibrillation; Bisphosphonates; Congestive heart failure; Osteoporosis