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Assessment of cardiovascular safety of anti-osteoporosis drugs

Assessment of cardiovascular safety of anti-osteoporosis drugs
Assessment of cardiovascular safety of anti-osteoporosis drugs
The incidence of osteoporosis and cardiovascular disease increases with age, and there are potentially shared mechanistic associations between the two conditions. It is therefore highly relevant to understand the cardiovascular implications of osteoporosis medications. These are presented in this narrative review. Calcium supplementation could theoretically cause atheroma formation via calcium deposition, and in one study was found to be associated with myocardial infarction, but this has not been replicated. Vitamin D supplementation has been extensively investigated for cardiac benefit, but no consistent effect has been found. Despite findings in the early 21st century that menopausal hormone therapy was associated with coronary artery disease and venous thromboembolism (VTE), this therapy is now thought to be potentially safe (from a cardiac perspective) if started within the first 10 years of the menopause. Selective estrogen receptor modulators (SERMs) are associated with increased risk of VTE and may be related to fatal strokes (a subset of total strokes). Bisphosphonates could theoretically provide protection against atheroma. However, data from randomised trials and observational studies have neither robustly supported this nor consistently demonstrated the potential association with atrial fibrillation. Denosumab does not appear to be associated with cardiovascular disease and, although parathyroid hormone analogues are associated with palpitations and dizziness, no association with a defined cardiovascular pathology has been demonstrated. Finally, romosozumab has been shown to have a possible cardiovascular signal, and therefore post-market surveillance of this therapy will be vital.
0012-6667
1537-1552
Fuggle, Nicholas
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Cooper, Cyrus
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Harvey, Nicholas
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Al-Daghri, Nasser M.
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Brandi, Maria Luisa
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Bruyere, Olivier
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Cano, Antonio
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Dennison, Elaine
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Diez-Pérez, A.
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Kaufman, Jean-Marc
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Palacios, Santiago
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Prieto-Alhambra, D
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Rozenberg, S.
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Thomas, T.
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Trémollieres, Florence
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Rizzoli, René
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Kanis, J. A.
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Reginster, Jean Yves
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Fuggle, Nicholas
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Cooper, Cyrus
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Harvey, Nicholas
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Al-Daghri, Nasser M.
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Brandi, Maria Luisa
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Bruyere, Olivier
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Cano, Antonio
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Dennison, Elaine
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Diez-Pérez, A.
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Kaufman, Jean-Marc
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Palacios, Santiago
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Prieto-Alhambra, D
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Rozenberg, S.
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Thomas, T.
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Trémollieres, Florence
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Rizzoli, René
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Kanis, J. A.
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Reginster, Jean Yves
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Fuggle, Nicholas, Cooper, Cyrus, Harvey, Nicholas, Al-Daghri, Nasser M., Brandi, Maria Luisa, Bruyere, Olivier, Cano, Antonio, Dennison, Elaine, Diez-Pérez, A., Kaufman, Jean-Marc, Palacios, Santiago, Prieto-Alhambra, D, Rozenberg, S., Thomas, T., Trémollieres, Florence, Rizzoli, René, Kanis, J. A. and Reginster, Jean Yves (2020) Assessment of cardiovascular safety of anti-osteoporosis drugs. Drugs, 80 (15), 1537-1552. (doi:10.1007/s40265-020-01364-2).

Record type: Article

Abstract

The incidence of osteoporosis and cardiovascular disease increases with age, and there are potentially shared mechanistic associations between the two conditions. It is therefore highly relevant to understand the cardiovascular implications of osteoporosis medications. These are presented in this narrative review. Calcium supplementation could theoretically cause atheroma formation via calcium deposition, and in one study was found to be associated with myocardial infarction, but this has not been replicated. Vitamin D supplementation has been extensively investigated for cardiac benefit, but no consistent effect has been found. Despite findings in the early 21st century that menopausal hormone therapy was associated with coronary artery disease and venous thromboembolism (VTE), this therapy is now thought to be potentially safe (from a cardiac perspective) if started within the first 10 years of the menopause. Selective estrogen receptor modulators (SERMs) are associated with increased risk of VTE and may be related to fatal strokes (a subset of total strokes). Bisphosphonates could theoretically provide protection against atheroma. However, data from randomised trials and observational studies have neither robustly supported this nor consistently demonstrated the potential association with atrial fibrillation. Denosumab does not appear to be associated with cardiovascular disease and, although parathyroid hormone analogues are associated with palpitations and dizziness, no association with a defined cardiovascular pathology has been demonstrated. Finally, romosozumab has been shown to have a possible cardiovascular signal, and therefore post-market surveillance of this therapy will be vital.

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Manuscript - CV safety resubmission (clean) - Accepted Manuscript
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Accepted/In Press date: 23 June 2020
Published date: 28 July 2020

Identifiers

Local EPrints ID: 443282
URI: http://eprints.soton.ac.uk/id/eprint/443282
ISSN: 0012-6667
PURE UUID: 855f36ba-ec9a-400d-b391-7ba7b73f651d
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512
ORCID for Elaine Dennison: ORCID iD orcid.org/0000-0002-3048-4961

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Date deposited: 20 Aug 2020 16:30
Last modified: 26 Nov 2021 05:57

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Contributors

Author: Nicholas Fuggle
Author: Cyrus Cooper ORCID iD
Author: Nicholas Harvey ORCID iD
Author: Nasser M. Al-Daghri
Author: Maria Luisa Brandi
Author: Olivier Bruyere
Author: Antonio Cano
Author: Elaine Dennison ORCID iD
Author: A. Diez-Pérez
Author: Jean-Marc Kaufman
Author: Santiago Palacios
Author: D Prieto-Alhambra
Author: S. Rozenberg
Author: T. Thomas
Author: Florence Trémollieres
Author: René Rizzoli
Author: J. A. Kanis
Author: Jean Yves Reginster

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