Oral bisphosphonate use and age‐related macular degeneration: retrospective cohort and nested case–control study

Abstract

Our objective here was to determine whether oral bisphosphonate (BP) use is associated with the incidence of age-related macular degeneration (AMD). We performed a population-based study using electronic health records from UK primary care (Clinical Practice Research Datalink). A cohort of 13,974 hip fracture patients (1999-2013) was used to conduct (1) a propensity score-matched cohort analysis and (2) a nested case-control analysis. Hip fracture patients were aged ≥50 years without AMD diagnosis before hip fracture date or in the first year of follow-up. Among 6208 matched patients and during 22,142 person-years of follow-up, 57 (1.8%) and 42 (1.4%) AMD cases occurred in BP users and non-BP users, respectively. The survival analysis model did not provide significant evidence of a higher risk of AMD in BP users (subhazard ratio: 1.60; 95% confidence interval (CI): 0.95-2.72; P = 0.08), although there was a significant increased risk among BP users with high medication possession ratio (MPR) (top quartile) relative to non-BP users (odds ratio: 5.08, 95% CI: 3.11-8.30; P < 0.001, respectively). Overall, oral BP use was not associated with an increased risk of AMD in this cohort of hip fracture patients, although the risk increased significantly with higher MPR. More data are needed to confirm these findings.

Osteoporosis, bisphosphonates, and ocular inflammation

“…32 Other study showed that oral bisphosphonates use was not associated with an increased risk of ARMD, but the risk increased considerably with higher medication possession ratio. 3…”

“…1,2 Bisphosphonates are the main therapeutic intervention for the treatment of confirmed diagnosis of osteoporosis in both men and postmenopausal women, with additional indications for other diseases. 3,[8][9][10][11][12][13][14][15] Bisphosphonates have been shown to induce improvement of bone mineral density, suppression of osseous turnover and a real time reduction of fracture risk and morbidity. 12 However, bisphosphonates have been associated with some rare and severe adverse effects, such as atypical femur fractures, 3,4,9,10,13 other atypical fractures, 16 osteonecrosis of the jaw (ONJ), 3,4,8,9,13,[17][18][19][20] an increased risk of aseptic osteonecrosis (AON), 8 atrial fibrillation, 4,9,10,13,21 esophageal and colon cancer, 4,9,10,22 bone and muscle pain, 4,9,13 irregular heartbeat, gastrointestinal intolerance, upper gastrointestinal (GI) adverse effects, acute phase reaction, hypocalcemia, impaired fracture healing, renal complications, electrolyte imbalance, and ocular inflammation.…”

“…Osteoporosis is estimated to affect around one-tenth of women aged 60 and up to two-thirds of women aged 90, with approximately 200 million women affected worldwide. 3…”

“…4 Osteoporosis is estimated to affect around one-tenth of women aged 60 and up to two-thirds of women aged 90, with approximately 200 million women affected worldwide. 3 The prevalence of osteoporosis and the risk of osteoporosis-induced fracture is higher in women compared to men due to differences in bone mineral density (BMD), bone size, and bone strength between these two genders. 5,6 However, men have a tendency to show worse results after fractures.…”

“…Osteoporosis, as a musculoskeletal disease, is specified by low bone mass and degradation of bone microarchitecture, ending up in bone weakness and susceptibility to fracture. [1][2][3] Osteoporosis is induced by the cumulative effect of bone resorption in excess of bone formation. 4 Osteoporotic fractures are associated with considerable morbidity, mortality, and high healthcare expenses.…”