Carpal Tunnel Syndrome Associated with Oral Bisphosphonates. A Population-Based Cohort Study

Abstract

BackgroundBisphosphonates are widely used to prevent osteoporotic fractures. Some severe musculoskeletal reactions have been described with this medication; among them, some cases of carpal tunnel syndrome. Thus, the aim of this study was to explore whether bisphosphonates may be associated with this syndrome.MethodsA cohort study was conducted to compare exposed to unexposed women; the exposed group was that composed of women having received at least one prescription of an oral bisphosphonate. For the purpose, we used information from The Health Improvement Network (THIN) database. The outcome of interest was defined as those women diagnosed with carpal tunnel syndrome. A survival analysis was performed; the Cox proportional hazard model was used to calculate hazard ratios and 95% confidence intervals, and to adjust for identified confounding variables.ResultsOut of a sample of 59,475 women older than 51 years, 19,825 were treated with bisphosphonates during the period studied. No differences in age distribution or mean follow-up time were observed between the two groups in comparison. Overall, there were 572 women diagnosed with carpal tunnel syndrome, 242 (1.2%) in the group exposed to bisphosphonates, and 330 (0.8%) in the unexposed. An adjusted hazard ratio of developing carpal tunnel syndrome of 1.38 (95%CI, 1.15–1.64) was found for women exposed to bisphosphonates; no significant changes in the hazard ratios were found when considering different levels of bisphosphonate exposure.ConclusionsAn increased risk of carpal tunnel syndrome is associated with the use of bisphosphonates in postmenopausal women.

Histologic evaluation of femoral nerve demyelinating and axonal neuropathy in Wistar rats due to alendronate intake: a randomised study

“…Nevertheless, long-term BP use is associated with multiple rare but severe adverse effects. More specifically, adverse effects include events of the gastrointestinal tract, such as abdominal pain, nausea, dyspepsia, vomiting and diarrhea [6], osteonecrosis of the jaw [7] and the maxillae [8], osteonecrosis of the external ear canal [9], hypocalcaemia [10,11], atypical femoral fractures [12] or subtrochanteric fractures [13], carpal tunnel syndrome [14], renal failure [15], oesophageal cancer [16], uveitis with macular edema [17], interface dermatitis [18], orbital inflammation [19] and non-contact allergenic drug-induced baboon syndrome [20]. Recently, according to Cibickova et al [21] experimental evidence has been provided that supports the idea of alendronate inhibiting cholesterol biosynthesis on the central nervous system.…”

Re: Letter written in reaction to “Pregabalin prescriptions in the United Kingdom: a drug utilisation study of The Health Improvement Network (THIN) primary care database”, by Pottegård et al. - The authors (Asomaning et al.) respond

“…Both databases have individual strengths and weaknesses, and both are considered well validated and well recognised for pharmacoepidemiologic research with numerous publications. (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) Regarding the first issue raised by Potteg ard et al, i.e. the definition of pregabalin exposure in our study, in a 2011 presentation, Thompson et al (16) demonstrated a very high correlation between prescribing recorded in THIN data and drug dispensing in England.…”

Clinical and electrophysiological evaluation of neutral wrist nocturnal splinting in patients with carpal tunnel syndrome

“…Studies have shown that females with the highest body mass index (BMI) are more likely to develop CTS24, 25 ) . A BMI ≥30 kg/m 2 almost doubled the risk of CTS, and when BMI was assessed as a continuous variable, the hazard ratio increased approximately linearly with increasing BMI24 ) .…”

“…In this study, 90% of patients with CTS were female, and the mean age was approximately 50 years, which is consistent with the epidemiological data 3 ) . Studies have shown that females with the highest body mass index (BMI) are more likely to develop CTS 24 , 25 ) . A BMI ≥30 kg/m 2 almost doubled the risk of CTS, and when BMI was assessed as a continuous variable, the hazard ratio increased approximately linearly with increasing BMI 24 ) .…”