Vitamin D and bisphosphonates therapies for osteoporosis are associated with different risks of atrial fibrillation in women

Abstract

Osteoporosis and atrial fibrillation (AF) are common in post-menopausal women. Vitamin D and bisphosphonates are widely used to treat osteoporosis, and these may have different effects on the risk of AF.The goal of this study was to evaluate whether different agents for treating osteoporosis modulate the risk of AF in a population-based database.We identified 20,788 female patients suffering from osteoporosis who were or were not treated with vitamin D or bisphosphonates using the Taiwan National Health Insurance nationwide database from 2000 to 2008 and followed them up for 5 consecutive years to determine if they had a new diagnosis of AF after the diagnosis of osteoporosis.There were 14 (2.67%) new AF diagnoses in osteoporosis patients treated with bisphosphonates, one (0.28%) new AF diagnosis in patients treated with vitamin D, and 279 (1.40%) new AF diagnoses in patients who were not treated with vitamin D or bisphosphonates (neither group). Osteoporosis patients who received bisphosphonates showed a higher incidence of AF occurrence than those that were not treated with bisphosphonates (P = .015). In contrast, 1 patient who received vitamin D had a new diagnosis of AF during the study period; thus, the incidence was significantly lower than that in the patients treated with bisphosphonates (P = .007). In addition, the patients who were treated with vitamin D had a lower incidence of AF than did those who were not treated with either vitamin D or bisphosphonates (P = .074). Kaplan–Meier analysis also showed a significant difference in AF occurrence in different groups during the 5-year follow-up (P = .010).Different treatment for osteoporosis may carry diverse risks of AF occurrence. Vitamin D may have potential beneficial effects of reducing AF occurrence in osteoporosis patients.

Bisphosphonates and cardiovascular risk in elderly patients with previous cardiovascular disease: a population-based nested case-control study in Italy

“…21 An increased AF risk was also reported from a recently published observational study from Taiwan, which yet is not strictly comparable with our study, as BPs were compared to vitamin D rather than to other treatments, and the findings were based on small numbers. 22…”

“…When comparing results between studies, one must bear in mind the differences in the study populations. For example, the most recent observational study compared BP treatment versus vitamin D and none, rather than different active BP treatments 22 (Yang). Our cases and controls were part of a cohort of patients with pre-existing cardiovascular conditions, and this may lower external validity, that is, results may not be fully comparable with those reported by other researchers.…”

“…Conflicting results are also coming from observational research. While several studies suggest an increased risk of acute myocardial infarction (AMI) 18 and AF among BP users, 13,14,19–22 other studies did not find any association between exposure to BPs and increased cardiovascular risk. 23–26 In one study, the increased risk was limited to AMI and only for longer exposure to BPs.…”

The Association between Treatment with Bisphosphonates and the Risk of Atrial Fibrillation: A Meta-Analysis of Observational Studies

“…8,9) Studies evaluating the association between treatment with BPs and an increased risk of AF have yielded conflicting results, making the association between BPs with AF uncertain. [3][4][5]7,[10][11][12][13][14][15][16][17] Globally, AF is one of the most common clinical arrhythmias, especially in older persons. 18,19) The Framingham Heart Study reported that the prevalence of AF has increased by three-folds over the past 50 years.…”

Melatonin restores osteoporosis-impaired osteogenic potential of bone marrow mesenchymal stem cells and alleviates bone loss through the HGF/PTEN/Wnt/β-catenin axis

“…1 Postmenopausal women are more likely than men to suffer from osteoporosis. 2 Risk factors for the disease include age, glucocorticoid use, and decreased bone mineral density (BMD). 3 The impairment of osteoblast differentiation and bone formation is also a cause of osteoporosis.…”