Oral bisphosphonates and incidence of cancers in patients with osteoporosis: a systematic review and meta-analysis

Deng, Yingfang; Zhang, Zhen; Jia, Xi; Cheng, Wenke; Zhou, Xixi; Liu, Yi; Wang, Miaozhou

doi:10.1007/s11657-018-0552-3

Cited by 9 publications

(10 citation statements)

References 20 publications

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“…With regard to female cancers, our findings are consistent with previous studies that bisphosphonates could reduce the risk of breast 23 , 26 , 67 , 68 and endometrial cancer, 22 , 24 but no significant link was observed in ovarian cancer. 24 This might be due to the oestrogen receptor (ER) involved in the anticancer effect of bisphosphonates.…”

Section: Discussionsupporting

confidence: 92%

“…With regard to all-cause cancer, our results are largely consistent with previous meta-analyses in similar contexts, supporting that the association between bisphosphonates and the risk of all-cause cancer is not statistically significant. 26 The difference is that their study only included 13 cohort studies. Because this study had more sample size and the total number of cancer cases, we could examine more types of cancers and obtain higher statistical power.…”

Section: Discussionmentioning

confidence: 99%

“…The study by Oh et al 25 showed that there was no significant association between bisphosphonates and the risk of oesophageal cancer (RR = 0.96, 95% CI: 0.65–1.42), which was consistent with our results and other three meta-analyses. 20 , 21 , 26 However, Andrici et al 70 found that bisphosphonates might increase the risk of oesophageal cancer (OR = 1.74, 95% CI: 1.19–2.55). Similarly, the results regarding the association between bisphosphonates and the risk of gastric cancer are inconsistent.…”

Section: Discussionmentioning

confidence: 99%

“… 15 – 24 For instance, Yang et al 19 suggested that the use of bisphosphonates might decrease the risk of colorectal cancer by 11% (RR = 0.89, 95% CI: 0.80–0.99), while Oh et al 25 found no significant association between the use of bisphosphonates and colorectal cancer (RR = 0.62, 95% CI: 0.30–1.29). To the best of our knowledge, there was currently only one meta-analysis by Deng et al 26 on the use of bisphosphonates and the risk of all-cause cancers, which only included 13 cohort studies and analysed the association in mixed genders and females.…”

Section: Introductionmentioning

confidence: 99%

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Bisphosphonates and risk of cancers: a systematic review and meta-analysis

Gao

Zhang

et al. 2020

Br J Cancer

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Background It is unclear whether bisphosphonates are associated with risk of cancers. Therefore, this meta-analysis aimed to evaluate the effect of bisphosphonates on overall cancers. Methods A search in Pubmed, Embase, Cochrane Library and Web of Science databases was conducted, from the inception date of each resource to September 26, 2019. The summarised effect estimates with 95% CIs were calculated using a random-effect model. Heterogeneity and publication bias were explored. Results Thirty-four articles were included in this study (4,508,261 participants; 403,196 cases). The results revealed that bisphosphonates significantly decreased the risk of colorectal cancer (RR = 0.89, 95% CI: 0.81–0.98), breast cancer (RR = 0.87, 95% CI: 0.82–0.93) and endometrial cancer (RR = 0.75, 95% CI: 0.61–0.94), but no significant association was observed in all-cause cancer. Furthermore, nitrogen-containing bisphosphonates only had protective effects both on breast cancer (RR = 0.94, 95% CI: 0.90–0.99) and endometrial cancer (RR = 0.70, 95% CI: 0.54–0.92). Non-nitrogen-containing bisphosphonates tended to increase the risk of liver cancer (RR = 2.14, 95% CI: 1.23–3.72) and pancreas cancer (RR = 1.75, 95% CI: 1.32–2.33). Conclusion Bisphosphonates are significantly associated with risk reduction of colorectal, breast and endometrial cancer, especially nitrogen-containing bisphosphonates. It should be noted that non-nitrogen-containing bisphosphonates might increase the risk of liver and pancreas cancer. Large prospective cohort studies are needed to find the causal association between bisphosphonates and risk of cancers.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bisphosphonates and risk of cancers: a systematic review and meta-analysis

Gao

Zhang

et al. 2020

Br J Cancer

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“…Alendronic acid is generally a well‐tolerated medication, however, there are well‐established adverse effects such as medication‐related osteonecrosis of the jaw 2 and upper gastro‐intestinal disturbances, particularly erosive oesophagitis 3 . There is existing evidence of bisphosphonate‐induced oral ulcerations 4,5 and this diagnosis needs to be considered for patients presenting with unexplained ulceration of the oral mucosa.…”

mentioning

confidence: 99%

Alendronic acid‐induced oral mucosal ulceration: two case reports

et al. 2020

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Alendronic acid is generally a well-tolerated medication, however, there are well-established adverse effects known within dentistry, such as medication-related osteonecrosis of the jaw and upper gastro-intestinal disturbances, particularly erosive oesophagitis. There is growing evidence Case 1An 84-year-old female patient attended the emergency dental department, having been referred from her General Dental Practitioner complaining of

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Supporting patients to get the best from their osteoporosis treatment: a rapid realist review of what works, for whom, and in what circumstance

Paskins

Babatunde²,

Sturrock³

et al. 2022

Osteoporos Int

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Systematic reviews that examine effectiveness of interventions to improve medicines optimisation do not explain how or why they work. This realist review identified that interventions which effectively optimise medicines use in osteoporosis include opportunities to address patients' perceptions of illness and treatment and/or support primary care clinician decision making. Introduction In people with osteoporosis, adherence to medicines is poorer than other diseases and patients report followup is lacking, and multiple unmet information needs. We conducted a rapid realist review to understand what contextual conditions and mechanisms enable interventions to support osteoporosis medication optimisation. Methods A primary search identified observational or interventional studies which aimed to improve medicines adherence or optimisation; a supplementary second search identified research of any design to gain additional insights on emerging findings. Extracted data was interrogated for patterns of context-mechanism-outcome configurations, further discussed in team meetings, informed by background literature and the Practicalities and Perception Approach as an underpinning conceptual framework. Results We identified 5 contextual timepoints for the person with osteoporosis (identifying a problem; starting medicine; continuing medicine) and the practitioner and healthcare system (making a diagnosis and giving a treatment recommendation; reviewing medicine). Interventions which support patient-informed decision making appear to influence long-term commitment to treatment. Supporting patients' practical ability to adhere (e.g. by lowering treatment burden and issuing reminders) only appears to be helpful, when combined with other approaches to address patient beliefs and concerns. However, few studies explicitly addressed patients' perceptions of illness and treatment. Supporting primary care clinician decision making and integration of primary and secondary care services also appears to be important, in improving rates of treatment initiation and adherence. Conclusions We identified a need for further research to identify a sustainable, integrated, patient-centred, and cost-and clinically effective model of long-term care for people with osteoporosis.

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Oral bisphosphonates and incidence of cancers in patients with osteoporosis: a systematic review and meta-analysis

Cited by 9 publications

References 20 publications

Bisphosphonates and risk of cancers: a systematic review and meta-analysis

Bisphosphonates and risk of cancers: a systematic review and meta-analysis

Alendronic acid‐induced oral mucosal ulceration: two case reports

Supporting patients to get the best from their osteoporosis treatment: a rapid realist review of what works, for whom, and in what circumstance

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