Heart Failure, Arrhythmia Risk Increased With Zoledronic Acid

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Research presented at the American Society for Bone and Mineral Research suggests zoledronic acid carries a high cardiovascular event risk.
Research presented at the American Society for Bone and Mineral Research suggests zoledronic acid carries a high cardiovascular event risk.

Patients treated with zoledronic acid had a higher risk for heart failure, among other cardiovascular conditions, according to a study presented at the American Society for Bone and Mineral Research (ASBMR) 2017 Annual Meeting held September 8-11 in Denver, Colorado.1

Researchers from the University of Southern Denmark in Odense analyzed data from a 5-year propensity score matched cohort from 2 national health registries to determine the incidence of safety-related outcomes in patients treated with zoledronic acid (21,520 person-years) vs patients treated with oral bisphosphonates (63,020 person-years) or untreated patients (63,880 person-years).

During a median period of 2.4 years, the researchers observed a higher risk for heart failure in patients treated with zoledronic acid compared with patients treated with oral bisphosphonates (hazard ratio [HR], 121; 95% CI, 1.09-1.34). Similarly, the risk for atrial fibrillation (HR, 1.07; 95% CI, 1.07-1.28) and other arrhythmias (HR, 1.18; 95% CI, 1.08-1.24), as well as heart failure (HR, 1.39; 95% CI, 1.25-1.55), was significantly higher in patients treated with zoledronic acid compared with in untreated patients.

No major difference in stroke risk was recorded among the groups.

The researchers could not definitively conclude that the higher rates of cardiovascular events were related to a drug effect, a difference in risk at baseline, or both, because of the study's observational nature.

"It is possible that [zoledronic acid] was targeted to a frailer subset of patients than [oral bisphosphonates]," they wrote. "[Al]though propensity score matching and confounder adjustment was employed to reduce the influence of confounding, information on confounders such as smoking, alcohol, exercise, and [body mass index] is not available in national registries."

Reference

Abrahamsen B, Rubin KH, Möller S, Choudhury A, Eriksen EF, Andersen M. Cardiovascular safety of zoledronic acid compared with oral bisphosphonates and untreated population controls: an observational cohort study using Danish and Swedish National Health registries. Presented at: American Society for Bone and Mineral Research (ASBMR) 2017 Annual Meeting; September 8-11, 2017; Denver, CO. Abstract MO0652.

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