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

Springer Science and Business Media LLC - Tập 33 - Trang 1579-1589 - 2022
S. Khalid1,2, S. Calderon-Larranaga3,4, A. Sami2, S. Hawley1,2,5, A. Judge1,2,4,5, N. Arden6, T. P. Van Staa7,8, C. Cooper2,9,10, B. Abrahamsen11, M. Kassim Javaid2, D. Prieto-Alhambra2,12
1Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
2Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
3Family and Community Medicine Teaching Unit of Granada, Cartuja University Health Centre, Andalusian Health Service (SAS), Granada, Spain
4Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
5Bristol NIHR Biomedical Research Centre, Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, UK
6Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Oxford, UK
7Centre for Health Informatics, University of Manchester, Manchester, UK
8Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
9Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
10NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
11Odense Patient Data Explorative Network OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
12GREMPAL (Grup de Recerca en Malalties Prevalents de L’Aparell Locomotor) Research Group, CIBERFes and Idiap Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain

Tóm tắt

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. 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. 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. 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. 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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Springer Science and Business Media LLC

Tập 33

1579-1589

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