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Comparative risk of acute myocardial infarction for anti-osteoporosis drugs in primary care: a meta-analysis of propensity-matched cohort findings from the UK Clinical Practice Research Database and the Catalan SIDIAP Database

Comparative risk of acute myocardial infarction for anti-osteoporosis drugs in primary care: a meta-analysis of propensity-matched cohort findings from the UK Clinical Practice Research Database and the Catalan SIDIAP Database
Comparative risk of acute myocardial infarction for anti-osteoporosis drugs in primary care: a meta-analysis of propensity-matched cohort findings from the UK Clinical Practice Research Database and the Catalan SIDIAP Database
Summary: the aim of this study was to evaluate the risk of acute myocardial infarction in patients taking osteoporosis medication. Patients were taken from the SIDIAP or CPRD database and were matched using propensity scores. Patients with diabetes and chronic kidney disease taking SERMs were at an increased risk. The results favour the cardiovascular safety of alendronate as a first-line choice for osteoporosis treatment.

Introduction: this study aims to evaluate the comparative safety of anti-osteoporosis drugs based on the observed risk of acute myocardial infarction while on treatment in a primary care setting.

Methods: this is a propensity-matched cohort study and meta-analysis. This study was conducted in two primary care record databases covering UK NHS (CPRD) and Catalan healthcare (SIDIAP) patients during 1995–2014 and 2006–2014, respectively. The outcome was acute myocardial infarction while on treatment. Users of alendronate (reference group) were compared to those of (1) other oral bisphosphonates (OBP), (2) strontium ranelate (SR), and (3) selective oestrogen receptor modulator (SERM), after matching on baseline characteristics (socio-demographics, fracture risk factors, comorbidities, and concomitant drug use) using propensity scores. Multiple imputation was used to handle missing data on confounders and competing risk modelling for the calculation of relative risk (sub-distribution hazard ratios (SHR)) according to therapy. Country-specific data were analysed individually and meta-analysed.

Results: a 10% increased risk of acute myocardial infarction was found in users of other bisphosphonates as compared to alendronate users within CPRD. The meta-analysis of CPRD and SIDIAP results showed a 9% increased risk in users of other bisphosphonate as compared to alendronate users. Sensitivity analysis showed SERMS users with diabetes and chronic kidney disease were at an elevated risk.

Conclusions: this study provides additional data on the risk of acute myocardial infarction in patients receiving osteoporosis treatment. The results favour the cardiovascular safety of alendronate as a first-line choice for osteoporosis treatment.
Acute myocardial infarction, CPRD, Osteoporosis treatment, SIDIAP
0937-941X
1579-1589
Khalid, S.
30756044-0ed2-4b5d-b230-2b389b0914c8
Calderon-Larranaga, S.
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Sami, A.
b42e7704-dc68-46ef-a642-bc2a83abdfa1
Hawley, S.
407712ed-30ba-4458-a0f3-f6278e219845
Judge, A.
53ccba98-13f0-4a06-b2ff-59a35616c990
Arden, N.
23af958d-835c-4d79-be54-4bbe4c68077f
Van Staa, T.P.
438cdc38-714e-48f4-8eb5-41b0de820064
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Abrahamsen, B.
fee8b1eb-c267-4d2a-952a-d1b9f20d0125
Kassim Javaid, M.
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Prieto-Alhambra, D.
051113cd-2da1-4e0d-aa4b-d7b1fe63cd12
Khalid, S.
30756044-0ed2-4b5d-b230-2b389b0914c8
Calderon-Larranaga, S.
9f1287d0-a088-4957-b055-bcdb5134d71e
Sami, A.
b42e7704-dc68-46ef-a642-bc2a83abdfa1
Hawley, S.
407712ed-30ba-4458-a0f3-f6278e219845
Judge, A.
53ccba98-13f0-4a06-b2ff-59a35616c990
Arden, N.
23af958d-835c-4d79-be54-4bbe4c68077f
Van Staa, T.P.
438cdc38-714e-48f4-8eb5-41b0de820064
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Abrahamsen, B.
fee8b1eb-c267-4d2a-952a-d1b9f20d0125
Kassim Javaid, M.
12781b29-34fa-4158-837b-daf452b8d4ed
Prieto-Alhambra, D.
051113cd-2da1-4e0d-aa4b-d7b1fe63cd12

Khalid, S., Calderon-Larranaga, S., Sami, A., Hawley, S., Judge, A., Arden, N., Van Staa, T.P., Cooper, C., Abrahamsen, B., Kassim Javaid, M. and Prieto-Alhambra, D. (2022) Comparative risk of acute myocardial infarction for anti-osteoporosis drugs in primary care: a meta-analysis of propensity-matched cohort findings from the UK Clinical Practice Research Database and the Catalan SIDIAP Database. Osteoporosis International, 33, 1579-1589. (doi:10.1007/s00198-021-06262-1).

Record type: Article

Abstract

Summary: the aim of this study was to evaluate the risk of acute myocardial infarction in patients taking osteoporosis medication. Patients were taken from the SIDIAP or CPRD database and were matched using propensity scores. Patients with diabetes and chronic kidney disease taking SERMs were at an increased risk. The results favour the cardiovascular safety of alendronate as a first-line choice for osteoporosis treatment.

Introduction: this study aims to evaluate the comparative safety of anti-osteoporosis drugs based on the observed risk of acute myocardial infarction while on treatment in a primary care setting.

Methods: this is a propensity-matched cohort study and meta-analysis. This study was conducted in two primary care record databases covering UK NHS (CPRD) and Catalan healthcare (SIDIAP) patients during 1995–2014 and 2006–2014, respectively. The outcome was acute myocardial infarction while on treatment. Users of alendronate (reference group) were compared to those of (1) other oral bisphosphonates (OBP), (2) strontium ranelate (SR), and (3) selective oestrogen receptor modulator (SERM), after matching on baseline characteristics (socio-demographics, fracture risk factors, comorbidities, and concomitant drug use) using propensity scores. Multiple imputation was used to handle missing data on confounders and competing risk modelling for the calculation of relative risk (sub-distribution hazard ratios (SHR)) according to therapy. Country-specific data were analysed individually and meta-analysed.

Results: a 10% increased risk of acute myocardial infarction was found in users of other bisphosphonates as compared to alendronate users within CPRD. The meta-analysis of CPRD and SIDIAP results showed a 9% increased risk in users of other bisphosphonate as compared to alendronate users. Sensitivity analysis showed SERMS users with diabetes and chronic kidney disease were at an elevated risk.

Conclusions: this study provides additional data on the risk of acute myocardial infarction in patients receiving osteoporosis treatment. The results favour the cardiovascular safety of alendronate as a first-line choice for osteoporosis treatment.

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Accepted/In Press date: 3 December 2021
e-pub ahead of print date: 9 February 2022
Published date: 1 July 2022
Additional Information: Funding Information: This work was partially funded by a Project Grant from the National Osteoporosis Society. This work was supported by the NIHR Biomedical Research Centre, Oxford. DPA is funded by a National Institute for Health Research Clinician Scientist award (CS-2013–13-012). Andrew Judge was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. This study has been approved by the Independent Scientific Advisory Committee (ISAC, protocol number 14_110). This study is based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The data is provided by patients and collected by the NHS as part of their care and support. The interpretation and conclusions contained in this study are those of the author/s alone. Funding Information: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare Cyrus Cooper reports Personal fees from Alliance for Better Bone Health, Amgen, Eli Lilly, GSK, Medtronic, Merck, Novartis, Pfizer, Roche, Servier, Takeda, and UCB. Kassim Javaid reports honoraria, unrestricted research grants, and travel and/or subsistence expenses from Amgen, Lilly UK, Shire, Internis, Consilient Health, Stirling Anglia Pharmaceuticals, Mereo Biopharma, Optasia Medical, Zebra Medical Vision, Kyowa Kirin Hakin, and UCB. Andrew Judge reports consultancy fees, lecture fees, and honoraria from Servier, UK Renal Registry, Oxford Craniofacial Unit, IDIAP Jordi Gol, and Freshfields Bruckhaus Deringer, is a member of the Data Safety and Monitoring Board (which involved receipt of fees) from Anthera Pharmaceuticals, Inc., and received consortium research grants from Roche. Bo Abrahamsen reports Institutional research grants UCB and Novartis. Advisory board and consulting fees UCB. Daniel Prieto Alhambra reports DPA’s institution received speaker fees from AMGEN and UCB Biopharma; consultancy fees from UCB Biopharma; research grants from UCB, Amgen, and Les Laboratoires Servier; and financial support to organise educational activities from Janssen (on behalf of IMI-funded EHDEN and EMIF consortiums) and Synapse Management Partners. Sara Khalid, Sara Calderon-Larranaga, Arvind Sami, Samuel Hawley, and Tjeerd P Van Staa declare that they have no conflict of interest.
Keywords: Acute myocardial infarction, CPRD, Osteoporosis treatment, SIDIAP

Identifiers

Local EPrints ID: 484563
URI: http://eprints.soton.ac.uk/id/eprint/484563
ISSN: 0937-941X
PURE UUID: fdf8aa57-f8ad-4d7a-bcea-6bb1c89bf39e
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 16 Nov 2023 17:48
Last modified: 16 Apr 2024 01:35

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Contributors

Author: S. Khalid
Author: S. Calderon-Larranaga
Author: A. Sami
Author: S. Hawley
Author: A. Judge
Author: N. Arden
Author: T.P. Van Staa
Author: C. Cooper ORCID iD
Author: B. Abrahamsen
Author: M. Kassim Javaid
Author: D. Prieto-Alhambra

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