Mayo Clinic Proceedings 85 (2010) 341-348. doi:10.4065/mcp.2009.0492Received by publisher: 0000-01-01Harvest Date: 2016-01-04 12:20:30DOI: 10.4065/mcp.2009.0492Page Range: 341-34

Objective To determine if bisphosphonates are associated with reduced risk of acute myocardial infarction (AMI). Patients and Methods A cohort of 14,256 veterans 65 years or older with femoral or vertebral fractures was selected from national administrative databases operated by the US Department of Veterans Affairs (VA), and were derived from encounters at VA facilities between October 1, 1998, and September 30, 2006. The time-to-first AMI was assessed in relation to bisphosphonate exposure as determined by records from the Pharmacy Benefits Management Database (PBM). Time-to-event analysis was performed using multivariable Cox proportional hazards regression. An adjusted survival analysis curve and a Kaplan-Meier survival curve were analyzed. Results After controlling for atherosclerotic cardiovascular disease risk factors and medications, bisphosphonate use was associated with an increased risk of incident AMI (HR 1.38; 95% CI, 1.08–1.77; P=0.012). The timing of AMI correlated closely with the timing of bisphosphonate therapy initiation. Conclusion These observations conflict with our hypothesis that bisphosphonates have anti-atherogenic effects, and may alter the risk-benefit ratio of bisphosphonate use for treatment of osteoporosis, especially in elderly men. However, further analysis and confirmation of these findings by prospective clinical trials is required.

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