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Jambon-Barbara C, Bernardeau C, Bezin J, Roustit M, Blaise S, Cracowski JL, Khouri C. Use of Bisphosphonates and the Risk of Skin Ulcer: A National Cohort Study Using Data from the French Health Care Claims Database. Drug Saf 2023; 46:905-916. [PMID: 37531074 DOI: 10.1007/s40264-023-01336-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Previous pre-clinical and pharmacovigilance disproportionality analyses highlighted a safety signal of cutaneous ulcer with bisphosphonate use. Therefore, our objective is to evaluate this risk and assess whether unmeasured confounding factors could explain this association. METHODS This study is a population-based cohort study from a representative sample (1/97th) of the French health insurance claims database: Echantillon Généraliste des Bénéficiaires (EGB) from 2006 to 2019. To limit the impact of our study design and methodological choices on any association between skin ulceration and exposure to bisphosphonates, we used several methods: a Cox proportional hazards analysis and a prior event rate ratio (PERR) analysis, using two propensity matched control groups, and either the first episode of incident ulceration or multiple event-time outcomes. RESULTS There were 7402 individuals newly exposed to bisphosphonates matched to 29,605 unexposed individuals on propensity score. The primary outcome was skin ulcer occurrence assessed by at least 2 deliveries of wound dressing during the period of one month. Among 6911 individuals newly exposed to bisphosphonates and 28,072 unexposed individuals with no previous skin ulcer, the Cox regression yielded a hazard ratio (HR) of 1.40 (95% CI 1.26-1.56) for newly exposed individuals. Among 7402 exposed and 29,605 unexposed individuals, the PERR analysis found a non-significant HR of 1.03 (95% CI 0.87-1.24). Results were similar on the different sensitivity analyses. CONCLUSION No association between bisphosphonate and skin ulcers was found in the French population. The association observed in previous pharmacovigilance studies and in the Cox regression analysis is likely due to unmeasured confounding factors.
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Affiliation(s)
- Clément Jambon-Barbara
- Pharmacovigilance Department, Grenoble Alpes University Hospital, 38043, Grenoble, France
| | - Claire Bernardeau
- Pharmacovigilance Department, Grenoble Alpes University Hospital, 38043, Grenoble, France
| | - Julien Bezin
- University Bordeaux, INSERM, BPH, Team AHeaD, U1219, 33000, Bordeaux, France
- Clinical Pharmacology Unit, CHU de Bordeaux, 33000, Bordeaux, France
| | - Matthieu Roustit
- University Grenoble Alpes, Inserm U1300, HP2, 38000, Grenoble, France
- University Grenoble Alpes, Inserm CIC1406, Grenoble Alpes University Hospital, 38000, Grenoble, France
| | - Sophie Blaise
- University Grenoble Alpes, Inserm U1300, HP2, 38000, Grenoble, France
- Department of Vascular Medicine, Grenoble Alpes University Hospital, University Grenoble Alpes, 38000, Grenoble, France
| | - Jean-Luc Cracowski
- Pharmacovigilance Department, Grenoble Alpes University Hospital, 38043, Grenoble, France
- University Grenoble Alpes, Inserm U1300, HP2, 38000, Grenoble, France
| | - Charles Khouri
- Pharmacovigilance Department, Grenoble Alpes University Hospital, 38043, Grenoble, France.
- University Grenoble Alpes, Inserm U1300, HP2, 38000, Grenoble, France.
- University Grenoble Alpes, Inserm CIC1406, Grenoble Alpes University Hospital, 38000, Grenoble, France.
- Centre Regional de Pharmacovigilance, CHU Grenoble Alpes, CS 10217, 38043, Grenoble Cedex 9, France.
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Stanoyevitch A, Zhang L, Sanz J, Follett RW, Bell DS. Association of Antiosteoporotic Medication Bisphosphonates and Denosumab with Primary Breast Cancer: An Electronic Health Record Cohort Study. ACTA ACUST UNITED AC 2021; 2:316-324. [PMID: 34476414 PMCID: PMC8409235 DOI: 10.1089/whr.2020.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/22/2022]
Abstract
Background: The risks of osteoporosis and breast cancer are increasing in elderly women. Bisphosphonates and denosumab are recommended for treatment of osteoporosis. They have different and overlapping pharmacodynamics and previous studies have shown conflicting results regarding their risk association with breast cancer. We intend to further look into this issue through a comparative study. Methods: Electronic health records of 91,626 women older than 50 years with no previous history of malignancy and no nonbreast cancer during follow-up were retrieved from southern California and retrospectively analyzed using univariate, bivariate, and log-rank tests. Medication use, breast cancer risk, and associated demographic and clinical history were assessed. Results: Over an average of 3.6 years follow-up, the breast cancer relative risks (RRs) counted after 365 days of latency are 1.12 (95% confidence interval [CI]: 0.64–1.97) for denosumab ever users and 0.37 (95% CI: 0.21–0.66) for bisphosphonates ever users, when covariates are comparable. The significant difference is supported by the Log-rank test (p = 0.0004). Excluding statins coprescribers, the breast cancer RR is 1.31 (0.71, 2.43) in denosumab group and 0.26 (0.11, 0.62) in bisphosphonates group. There is a reduced RR in statins ever users (0.47, 95% CI: 0.38–0.58), and the breast cancer risk difference is not significant between concomitant denosumab/statins and bisphosphonates/statins ever users with RR 0.65 (0.16, 2.58) versus 0.55 (0.26, 1.16), p = 0.692. Conclusions: Our data support an association of lower breast cancer risk with bisphosphonates use in elderly women. We did not observe a lower breast cancer risk in denosumab group; however, our data revealed a potential lower breast cancer risk in denosumab users with concurrent statins use and this requires further study.
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Affiliation(s)
- Alexander Stanoyevitch
- Department of Mathematics, California State University-Dominguez Hills, Carson, California, USA
| | - Lei Zhang
- Pathology Associates of Anaheim, Anaheim Regional Medical Center, Anaheim, California, USA
| | - Javier Sanz
- University of California at Los Angeles, Clinical and Translational Science Institute, Los Angeles, California, USA
| | - Robert W Follett
- University of California at Los Angeles, Clinical and Translational Science Institute, Los Angeles, California, USA
| | - Douglas S Bell
- University of California at Los Angeles, Clinical and Translational Science Institute, Los Angeles, California, USA
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Li YY, Gao LJ, Zhang YX, Liu SJ, Cheng S, Liu YP, Jia CX. Bisphosphonates and risk of cancers: a systematic review and meta-analysis. Br J Cancer 2020; 123:1570-1581. [PMID: 32901134 PMCID: PMC7652831 DOI: 10.1038/s41416-020-01043-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/28/2020] [Accepted: 08/14/2020] [Indexed: 01/02/2023] Open
Abstract
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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Affiliation(s)
- Yuan-Yuan Li
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Li-Jie Gao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yu-Xue Zhang
- Department of Preventive Medicine, Public Health School, Harbin Medical University, Harbin, China
| | - Shu-Juan Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shuo Cheng
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yu-Peng Liu
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China.
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Association Use of Bisphosphonates with Risk of Breast Cancer: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5606573. [PMID: 33102580 PMCID: PMC7568169 DOI: 10.1155/2020/5606573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 07/31/2020] [Indexed: 11/30/2022]
Abstract
Background Previous studies have investigated the association between the use of bisphosphonates and the development of breast cancer, which presented controversial results. Thus, this meta-analysis was conducted to summarize the current evidence of the association of bisphosphonate use with breast cancer risk. Methods A comprehensive search was conducted in PubMed, ISI Web of Knowledge, the Cochrane Library, and Embase from inception to March 2019 by two researches, who independently selected trials, retrieved relevant data, and assessed study quality. The summary relative risk (RR) for the use of bisphosphonates on the risks of developing breast cancer was calculated using a random-effect model. Results The present meta-analysis, which included four case-control studies, involving 55052 breast cancer cases, and seven retrospective cohort studies, involving 14641 breast cancer cases, assessed the effect of bisphosphonates on breast cancer risk. The random-effect model meta-analysis found a reduced risk of breast cancer with exposure to bisphosphonates with pooled RR of 0.87 (95% confidence interval [CI]: 0.80 to 0.94). The short-term use of bisphosphonates (<1 year) did not render significant alteration (RR = 0.92, 95% CI: 0.82 to 1.03), while a significant 26% risk reduction of breast cancer was noted with long-term use (>1 year) (RR = 0.74, 95% CI: 0.62 to 0.90). A protective effect of bisphosphonates was shown in contralateral breast cancer (RR = 0.41, 95% CI: 0.20 to 0.84). In terms of the type of bisphosphonates, a significant inverse relationship was noted for etidronate, with pooled RR of 0.87 (95% CI: 0.80 to 0.96). Conclusion This meta-analysis suggested that the use of bisphosphonates was associated with reduced risk of breast cancer, including contralateral breast cancer. Compared to other types of bisphosphonates, only etidronate showed a significant inverse relationship. Additionally, the long-term use (>1 year) of bisphosphonates was more significant in lowering breast cancer risk. Further randomized controlled trials are needed to verify this association. This trial is registered with PROSPERO (registration number: CRD42018105024) (registered on 29 August 2018).
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Abstract
Despite decades of laboratory, epidemiological and clinical research, breast cancer incidence continues to rise. Breast cancer remains the leading cancer-related cause of disease burden for women, affecting one in 20 globally and as many as one in eight in high-income countries. Reducing breast cancer incidence will likely require both a population-based approach of reducing exposure to modifiable risk factors and a precision-prevention approach of identifying women at increased risk and targeting them for specific interventions, such as risk-reducing medication. We already have the capacity to estimate an individual woman's breast cancer risk using validated risk assessment models, and the accuracy of these models is likely to continue to improve over time, particularly with inclusion of newer risk factors, such as polygenic risk and mammographic density. Evidence-based risk-reducing medications are cheap, widely available and recommended by professional health bodies; however, widespread implementation of these has proven challenging. The barriers to uptake of, and adherence to, current medications will need to be considered as we deepen our understanding of breast cancer initiation and begin developing and testing novel preventives.
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Affiliation(s)
- Kara L Britt
- Breast Cancer Risk and Prevention Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia.
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Kelly-Anne Phillips
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
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Rouach V, Goldshtein I, Buch A, Catane R, Chodick G, Stern N, Shalev V, Cohen D. The association between adherence with oral bisphosphonates and the risk of breast cancer in post-menopausal women. J Bone Oncol 2019; 16:100202. [PMID: 31334001 PMCID: PMC6616345 DOI: 10.1016/j.jbo.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 12/01/2022] Open
Abstract
Background Several observational studies have suggested a protective effect of oral bisphosphonates (BP) on the risk of breast cancer, but no such association has been seen in randomized control trials. The role of oral BP in breast cancer prevention remains unclear. Aim To investigate the association between different levels of BP exposure and breast cancer incidence in a cohort of osteoporotic post-menopausal women. Subjects and methods This historical prospective study was conducted using the computerized databases of Maccabi Healthcare Services (MHS) in Israel. Included in the study were osteopenic and osteoporotic women aged 55–75 years who started BP therapy between 1998 and 2012. The subjects were enrolled in MHS for at least 3 years before therapy initiation, and had a minimum follow-up of 5 years in MHS. Women with a previous cancer, and women treated with selective estrogen receptor modulators (SERMs) were excluded. BP exposure was expressed in quintiles of proportion of days covered (PDC) with BP during follow-up period and cancer incidence was ascertained by the Israel National Tumor Registry. Person-years of follow-up began on January 1st, 1998 and ended at the date of cancer diagnosis, death, or December 31st, 2012, whichever occurred first. Results A total of 11,717 patients (mean age = 66.87 ± 4.38) were eligible for the analysis. During a total of 130,252 person-years of follow-up, (mean 7.2 years) 173 incident cases of breast cancer were diagnosed. Compared to women with a PDC with BP of 20% or lower, the adjusted hazard ratio for breast cancer were HR = 0.81 (95%CI: 0.48–1.39), HR = 0.82 (95%CI: 0.50–1.33), HR = 0.72 (95%CI:0.45–1.15) and HR = 1.14 (95%CI:0.76–1.70) among women with 20–40%, 40–60%, 60%–80%, and 80% or higher, PDC, respectively. Conclusion In this study, we did not find a significant association between oral BP therapy for osteoporosis and the risk of breast cancer in postmenopausal women. The discrepancy between our results and the reports of such an association in observational studies might originate from an indication bias.
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Affiliation(s)
- Vanessa Rouach
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, 6 Weizmann street, Tel Aviv 64239, Israel.,Sackler School of Medicine, Tel Aviv University, Israel
| | - Inbal Goldshtein
- Epidemiology & Database Research, Maccabi Healthcare Services, Israel
| | - Assaf Buch
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, 6 Weizmann street, Tel Aviv 64239, Israel.,Sackler School of Medicine, Tel Aviv University, Israel
| | | | - Gabriel Chodick
- Epidemiology & Database Research, Maccabi Healthcare Services, Israel.,School of Public Health and Stanley Steyer Institute for Cancer Epidemiology and Research, Tel Aviv University, Israel
| | - Naftali Stern
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, 6 Weizmann street, Tel Aviv 64239, Israel
| | - Varda Shalev
- Epidemiology & Database Research, Maccabi Healthcare Services, Israel
| | - Daniel Cohen
- School of Public Health and Stanley Steyer Institute for Cancer Epidemiology and Research, Tel Aviv University, Israel
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Liu Y, Zhang X, Sun H, Zhao S, Zhang Y, Li D, Zhang Q, Zhao Y. Bisphosphonates and primary breast cancer risk: an updated systematic review and meta-analysis involving 963,995 women. Clin Epidemiol 2019; 11:593-603. [PMID: 31410067 PMCID: PMC6645691 DOI: 10.2147/clep.s194056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/20/2019] [Indexed: 12/24/2022] Open
Abstract
Importance Prevention of primary breast cancer (BCa) in women is of great public health importance. The existing results from observational epidemiologic studies focused on the association between bisphosphonates and primary BCa risk have been inconsistent. Objective To update this systematic review and meta-analysis to assess the effect of bisphosphonates on primary BCa risk. Data sources We comprehensively searched MEDLINE, EMBASE, Cochrane libraries, ProQuest, and Web of Science through June 25, 2018 for relevant studies. Study selection Epidemiological studies that assessed the effect of bisphosphonates on the risk of primary BCa in women. Data extraction and synthesis We reported this meta-analysis according to the PRISMA guidelines. Available multivariable-adjusted effect estimates and corresponding 95% CIs were pooled with a random-effects model. Main outcomes and measures The prespecified main outcome was the risk of primary BCa. Results In total, five cohort studies involving 657,558 women and 12,991 primary BCa patients, three population-based case-control studies involving 54,701 primary BCa cases and 237,962 healthy controls and two randomized controlled trials (RCTs) involving 13,774 women and 165 primary BCa patients were included in this meta-analysis. Bisphosphonates were associated with a 12% decreased risk of primary BCa (RR, 0.88; 95% CI, 0.83–0.94). However, when we analyzed study designs separately, the pooled results from observational studies were inconsistent with that from RCTs. The observed association of primary BCa risk with long-term use (≥1 year) of bisphosphonates seemed to be more robust and stronger than that of short-term use (<1 year) (RR, 0.75; 95% CI, 0.66–0.84; and 0.90; 95% CI, 0.84–0.97; respectively). Conclusion This meta-analysis adds to the body of evidence for an association between bisphosphonates and a significantly decreased risk of primary BCa. However, future large-scale RCTs are required to validate this concern.
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Affiliation(s)
- Yupeng Liu
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, People's Republic of China.,Department of Epidemiology, Public Health School of Harbin Medical University, Harbin 150081, People's Republic of China
| | - Xiaosan Zhang
- Department of Internal Medicine, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, People's Republic of China
| | - Hongru Sun
- Department of Epidemiology, Public Health School of Harbin Medical University, Harbin 150081, People's Republic of China
| | - Shu Zhao
- Department of Medical Oncology, The Third Affiliated Hospital of Harbin Medical University, Heilongjiang Cancer Hospital, Harbin 150081, People's Republic of China
| | - Yuxue Zhang
- Department of Preventive Medicine, Public Health School of Harbin Medical University, Harbin 150081, People's Republic of China
| | - Dapeng Li
- Department of Epidemiology, Public Health School of Harbin Medical University, Harbin 150081, People's Republic of China
| | - Qingyuan Zhang
- Department of Medical Oncology, The Third Affiliated Hospital of Harbin Medical University, Heilongjiang Cancer Hospital, Harbin 150081, People's Republic of China
| | - Yashuang Zhao
- Department of Epidemiology, Public Health School of Harbin Medical University, Harbin 150081, People's Republic of China
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Oral bisphosphonate use and the risk of female breast, ovarian, and cervical cancer: a nationwide population-based cohort study. Arch Osteoporos 2019; 14:41. [PMID: 30888545 DOI: 10.1007/s11657-019-0588-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/04/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED Bisphosphonate use was not associated with the risk of female breast, ovarian, or cervical cancer. The results according to bisphosphonate type or concurrent drug uses were not associated with the cancer risk. The protective effect of bisphosphonate use on female breast cancer was significant in the low comorbidity group. PURPOSE Despite the antitumor mechanisms, the effect of bisphosphonates on the risk of cancer is still unclear. We investigated the association between oral bisphosphonate use and the development of female breast, ovarian, and cervical cancer. METHODS We accomplished a population-based cohort study using the National Health Insurance Services (NHIS) database. A total of 204,525 participants were included in a cohort, and we identified the incident cases of each cancer from 2007 to 2013. We assessed cumulative bisphosphonate exposure from 2003 to 2006 using the defined daily dose (DDD) system. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were presented to assess the association between bisphosphonate use and cancer incidence using multivariate Cox proportional hazard regression models. Subgroup analyses were performed to assess cancer development according to risk factors and concurrent drug use. RESULTS There was a total of 1547, 266, and 370 incident cases of female breast, cervical, and ovarian cancer, respectively, during the study period of 1,367,294 person-years. Bisphosphonate exposure was not significantly associated with risk of female breast (adjusted HR (aHR), 0.78; 95% CI, 0.60-1.02), ovarian (aHR, 1.30; 95% CI, 0.82-2.07), nor cervical cancer (aHR, 0.70; 95% CI, 0.44-1.12). Further subgroup analyses also revealed no statistically significant effects of bisphosphonate use with various risk factors and concurrent drug use. CONCLUSIONS Our study showed no significant associations between bisphosphonate exposure and female breast, cervical, and ovarian cancer. In the future, large prospective studies or a meta-analysis would be needed to verify the associations.
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Deng Y, Zhang Z, Jia X, Cheng W, Zhou X, Liu Y, Wang M. Oral bisphosphonates and incidence of cancers in patients with osteoporosis: a systematic review and meta-analysis. Arch Osteoporos 2018; 14:1. [PMID: 30560459 DOI: 10.1007/s11657-018-0552-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/29/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE Several previous studies have shown that oral bisphosphonates (BPs) are associated with the incidence of 13 specific cancers, including lung cancer, esophageal cancer, gastric cancer, and colorectal cancer (CRC). However, the findings are heterogeneous. METHODS AND RESULTS Relevant studies published in databases such as PubMed, Embase database, and Cochrane library were systematically retrieved from inception to August 25th, 2018, regardless of language, by two investigators independently. Afterwards, the maximum adjusted hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were extracted from the retrieved studies. Finally, 13 cohort studies involving 1,510,763 participants were enrolled into this meta-analysis. No significant relationship was found between oral BPs and the risk of all-cause cancer in osteoporosis (OP) patients among the entire population (HR 0.97, 95% CI 0.80-1.18; I2 92.5%). Besides, oral BPs could remarkably reduce the incidence of breast cancer (HR 0.79, 95% CI 0.68-0.92; I2 54%) and endometrial cancer (HR 0.79, 95% CI 0.64-0.96; I2 0%) in postmenopausal OP females. In addition, oral BPs were also found to evidently reduce the incidence of upper gastrointestinal cancer in OP patients among the entire population (HR 0.73, 95% CI 0.54-0.98; I2 36.1%). However, oral BPs may lead to increased risk of liver cancer in mixed genders (HR 1.69, 95% CI 1.03-2.77; I2 30.7%). CONCLUSIONS Taken together, oral BPs do not increase the risk of incidence of all-cause cancer; instead, they can reduce the incidence of breast, endometrial, and upper gastrointestinal cancers among the postmenopausal OP females. Our analysis stratified by gender suggests that oral BPs may increase the incidence of liver cancer in mixed genders, while no significant association was observed in females. Careful analysis of post-marketing data should be conducted to address the clinical relevance of our results on the putative association of oral BP use and liver cancer suggested by our meta-analysis.
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Affiliation(s)
- Yingfang Deng
- Department of Oncology, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, Xining, 810000, China
| | - Zhen Zhang
- Department of Oncology, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, Xining, 810000, China
| | - Xi Jia
- Department of geriatric diseases, Zaozhuang Mental Health Center, Zaozhuang, China
| | - Wenke Cheng
- Department of Cardiology, Affiliated Hospital of Qinghai University, Xining, China
| | - Xixi Zhou
- Department of Oncology, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, Xining, 810000, China
| | - Yi Liu
- Department of Oncology, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, Xining, 810000, China
| | - Miaozhou Wang
- Department of Oncology, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, Xining, 810000, China.
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Non-hormonal Chemoprevention. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fournier A, Mesrine S, Gelot A, Fagherazzi G, Baglietto L, Clavel-Chapelon F, Boutron-Ruault MC, Chabbert-Buffet N. Use of Bisphosphonates and Risk of Breast Cancer in a French Cohort of Postmenopausal Women. J Clin Oncol 2017; 35:3230-3239. [DOI: 10.1200/jco.2016.71.4337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To assess whether bisphosphonate (BP) use is associated with decreased breast cancer incidence in a cohort of postmenopausal women. Methods The study population included 64,438 postmenopausal women participating in the French E3N (Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale) prospective cohort, with data self-reported in biennial questionnaires matched with data from a drug reimbursement database. Exposure to BPs and the use of other osteoporosis treatments during follow-up were determined using reimbursement data. Other covariates (breast cancer risk factors, clinical risk factors for osteoporotic fractures, and bone mineral density surveillance) originated from the questionnaires. Hazard ratios (HRs) of breast cancer were estimated using Cox proportional hazards models, considering exposure as a time-varying variable. Results Over an average of 7.2 years of follow-up (2004 to 2011), 2,407 first primary breast cancer cases were identified. The HR of breast cancer associated with exposure to BPs was 0.98 (95% CI, 0.85 to 1.12). We found no effect modification by age, body mass index, time since menopause, use of hormone replacement therapy, use of calcium supplements, or use of vitamin D supplements. There was no heterogeneity across BP molecules and no trend according to cumulative dose, duration of use, or time since last use. We observed a decrease in breast cancer risk restricted to the year after treatment initiation (HR, 0.56; 95% CI, 0.36 to 0.87), which was likely explained by healthy screenee bias. Finally, we did not find any variation in HRs across breast carcinomas defined by their estrogen receptor or invasive or in situ status. Conclusion In our observational cohort of postmenopausal women observed from 2004 to 2011, BP use, likely prescribed for the management of osteoporosis, was not associated with decreased breast cancer incidence.
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Affiliation(s)
- Agnès Fournier
- Agnès Fournier, Sylvie Mesrine, Amandine Gelot, Guy Fagherazzi, Laura Baglietto, Françoise Clavel-Chapelon, and Marie-Christine Boutron-Ruault, Centre for Research in Epidemiology and Population Health (CESP), Inserm, Université Paris-Sud, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay; Agnès Fournier, Sylvie Mesrine, Amandine Gelot, Guy Fagherazzi, Laura Baglietto, Françoise Clavel-Chapelon, and Marie-Christine Boutron-Ruault, Gustave Roussy, Villejuif; Sylvie Mesrine
| | - Sylvie Mesrine
- Agnès Fournier, Sylvie Mesrine, Amandine Gelot, Guy Fagherazzi, Laura Baglietto, Françoise Clavel-Chapelon, and Marie-Christine Boutron-Ruault, Centre for Research in Epidemiology and Population Health (CESP), Inserm, Université Paris-Sud, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay; Agnès Fournier, Sylvie Mesrine, Amandine Gelot, Guy Fagherazzi, Laura Baglietto, Françoise Clavel-Chapelon, and Marie-Christine Boutron-Ruault, Gustave Roussy, Villejuif; Sylvie Mesrine
| | - Amandine Gelot
- Agnès Fournier, Sylvie Mesrine, Amandine Gelot, Guy Fagherazzi, Laura Baglietto, Françoise Clavel-Chapelon, and Marie-Christine Boutron-Ruault, Centre for Research in Epidemiology and Population Health (CESP), Inserm, Université Paris-Sud, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay; Agnès Fournier, Sylvie Mesrine, Amandine Gelot, Guy Fagherazzi, Laura Baglietto, Françoise Clavel-Chapelon, and Marie-Christine Boutron-Ruault, Gustave Roussy, Villejuif; Sylvie Mesrine
| | - Guy Fagherazzi
- Agnès Fournier, Sylvie Mesrine, Amandine Gelot, Guy Fagherazzi, Laura Baglietto, Françoise Clavel-Chapelon, and Marie-Christine Boutron-Ruault, Centre for Research in Epidemiology and Population Health (CESP), Inserm, Université Paris-Sud, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay; Agnès Fournier, Sylvie Mesrine, Amandine Gelot, Guy Fagherazzi, Laura Baglietto, Françoise Clavel-Chapelon, and Marie-Christine Boutron-Ruault, Gustave Roussy, Villejuif; Sylvie Mesrine
| | - Laura Baglietto
- Agnès Fournier, Sylvie Mesrine, Amandine Gelot, Guy Fagherazzi, Laura Baglietto, Françoise Clavel-Chapelon, and Marie-Christine Boutron-Ruault, Centre for Research in Epidemiology and Population Health (CESP), Inserm, Université Paris-Sud, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay; Agnès Fournier, Sylvie Mesrine, Amandine Gelot, Guy Fagherazzi, Laura Baglietto, Françoise Clavel-Chapelon, and Marie-Christine Boutron-Ruault, Gustave Roussy, Villejuif; Sylvie Mesrine
| | - Françoise Clavel-Chapelon
- Agnès Fournier, Sylvie Mesrine, Amandine Gelot, Guy Fagherazzi, Laura Baglietto, Françoise Clavel-Chapelon, and Marie-Christine Boutron-Ruault, Centre for Research in Epidemiology and Population Health (CESP), Inserm, Université Paris-Sud, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay; Agnès Fournier, Sylvie Mesrine, Amandine Gelot, Guy Fagherazzi, Laura Baglietto, Françoise Clavel-Chapelon, and Marie-Christine Boutron-Ruault, Gustave Roussy, Villejuif; Sylvie Mesrine
| | - Marie-Christine Boutron-Ruault
- Agnès Fournier, Sylvie Mesrine, Amandine Gelot, Guy Fagherazzi, Laura Baglietto, Françoise Clavel-Chapelon, and Marie-Christine Boutron-Ruault, Centre for Research in Epidemiology and Population Health (CESP), Inserm, Université Paris-Sud, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay; Agnès Fournier, Sylvie Mesrine, Amandine Gelot, Guy Fagherazzi, Laura Baglietto, Françoise Clavel-Chapelon, and Marie-Christine Boutron-Ruault, Gustave Roussy, Villejuif; Sylvie Mesrine
| | - Nathalie Chabbert-Buffet
- Agnès Fournier, Sylvie Mesrine, Amandine Gelot, Guy Fagherazzi, Laura Baglietto, Françoise Clavel-Chapelon, and Marie-Christine Boutron-Ruault, Centre for Research in Epidemiology and Population Health (CESP), Inserm, Université Paris-Sud, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay; Agnès Fournier, Sylvie Mesrine, Amandine Gelot, Guy Fagherazzi, Laura Baglietto, Françoise Clavel-Chapelon, and Marie-Christine Boutron-Ruault, Gustave Roussy, Villejuif; Sylvie Mesrine
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12
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Ou YJ, Chiu HF, Wong YH, Yang CC, Yang YH. Bisphosphonate use and the risk of breast cancer: a meta-analysis of observational studies. Pharmacoepidemiol Drug Saf 2017; 26:1286-1295. [PMID: 28857419 DOI: 10.1002/pds.4302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 04/04/2017] [Accepted: 07/31/2017] [Indexed: 11/06/2022]
Abstract
PURPOSE To summarize current evidence of the association of bisphosphonate use with breast cancer risk, we used a systematic review and meta-analysis of observational studies to explore this issue. METHODS A comprehensive search was conducted on PubMed, EMBASE, and the Cochrane Library. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using the random effects model. RESULTS Bisphosphonate use was associated with a 16% lower breast cancer risk (pool RR0.84, 95%CI 0.77-0.90, n = 8). A protective effect of bisphosphonate was found in cohort studies (RR 0.85, 95%CI 0.80-0.90, n = 4) and case-control studies (RR 0.78, 95%CI 0.64-0.96, n = 4).We also found that the use of bisphosphonate resulted in a statistically significant reduction in all breast cancer risk (RR 0.87, 95%CI 0.81-0.93) and greater reduction in invasive breast cancer risk (RR 0.78, 95%CI 0.68-0.91) and contralateral breast cancer risk (RR, 0.41; 95% CI, 0.20-0.84).With respect to the type of bisphosphonate, we found that alendronate and etidronate resulted significant reduction in breast cancer risk. The short-term use of bisphosphonate (<1 y) led to nonsignificant change (RR 0.93, 95%CI 0.86-1.00), but a significant 26% reduction of breast cancer risk was noted with long-term use (>1 y) (RR 0.74, 95%CI 0.66-0.83). CONCLUSIONS Our results supported bisphosphonate as being effective in preventing breast cancer, including invasive and contralateral breast cancer. Furthermore, the long-term use (>1 y) of bisphosphonate was more significant in lowering breast cancer risk.
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Affiliation(s)
- Ying-Ju Ou
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hui-Fen Chiu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pharmacology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yun-Hong Wong
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Chien Yang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pharmacy, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Yi-Hsin Yang
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
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13
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Ou YJ, Chiu HF, Wong YH, Yang YH. Bisphosphonate use and the risk of endometrial cancer: a meta-analysis of observational studies. Pharmacoepidemiol Drug Saf 2016; 25:1107-1115. [DOI: 10.1002/pds.4075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Ying-Ju Ou
- School of Pharmacy, College of Pharmacy; Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Pharmacy; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Hui-Fen Chiu
- Graduate Institute of Medicine; College of Medicine, Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Pharmacology; College of Medicine, Kaohsiung Medical University; Kaohsiung Taiwan
| | - Yun-Hong Wong
- Graduate Institute of Medicine; College of Medicine, Kaohsiung Medical University; Kaohsiung Taiwan
| | - Yi-Hsin Yang
- School of Pharmacy, College of Pharmacy; Kaohsiung Medical University; Kaohsiung Taiwan
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14
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Effectiveness of bisphosphonate use and risk of contralateral breast cancer and recurrence in women with early-stage breast cancer treated with tamoxifen. Breast Cancer Res Treat 2016; 156:379-89. [DOI: 10.1007/s10549-016-3763-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/17/2016] [Indexed: 10/22/2022]
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15
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Adler RA, El-Hajj Fuleihan G, Bauer DC, Camacho PM, Clarke BL, Clines GA, Compston JE, Drake MT, Edwards BJ, Favus MJ, Greenspan SL, McKinney R, Pignolo RJ, Sellmeyer DE. Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research. J Bone Miner Res 2016; 31:16-35. [PMID: 26350171 PMCID: PMC4906542 DOI: 10.1002/jbmr.2708] [Citation(s) in RCA: 373] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 09/04/2015] [Accepted: 09/07/2015] [Indexed: 12/19/2022]
Abstract
Bisphosphonates (BPs) are the most commonly used medications for osteoporosis. This ASBMR report provides guidance on BP therapy duration with a risk-benefit perspective. Two trials provided evidence for long-term BP use. In the Fracture Intervention Trial Long-term Extension (FLEX), postmenopausal women receiving alendronate for 10 years had fewer clinical vertebral fractures than those switched to placebo after 5 years. In the HORIZON extension, women who received 6 annual infusions of zoledronic acid had fewer morphometric vertebral fractures compared with those switched to placebo after 3 years. Low hip T-score, between -2 and -2.5 in FLEX and below -2.5 in HORIZON extension, predicted a beneficial response to continued therapy. Hence, the Task Force suggests that after 5 years of oral BP or 3 years of intravenous BP, reassessment of risk should be considered. In women at high risk, for example, older women, those with a low hip T-score or high fracture risk score, those with previous major osteoporotic fracture, or who fracture on therapy, continuation of treatment for up to 10 years (oral) or 6 years (intravenous), with periodic evaluation, should be considered. The risk of atypical femoral fracture, but not osteonecrosis of the jaw, clearly increases with BP therapy duration, but such rare events are outweighed by vertebral fracture risk reduction in high-risk patients. For women not at high fracture risk after 3 to 5 years of BP treatment, a drug holiday of 2 to 3 years can be considered. The suggested approach for long-term BP use is based on limited evidence, only for vertebral fracture reduction, in mostly white postmenopausal women, and does not replace the need for clinical judgment. It may be applicable to men and patients with glucocorticoid-induced osteoporosis, with some adaptations. It is unlikely that future trials will provide data for formulating definitive recommendations. © 2015 American Society for Bone and Mineral Research.
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Affiliation(s)
- Robert A Adler
- McGuire Veterans Affairs Medical Center and Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | | | - Douglas C Bauer
- University of California, San Francisco, San Francisco, CA, USA
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16
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Ottanelli S. Prevention and treatment of bone fragility in cancer patient. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2015; 12:116-29. [PMID: 26604936 PMCID: PMC4625767 DOI: 10.11138/ccmbm/2015.12.2.116] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
It is well known that fractures increase the risk of morbidity and mortality. The various mechanisms responsible for bone loss in cancer patients may have a different impact depending on the characteristics of the clinical case and correlates with the therapies used, or caused by the therapies used against cancer. Some hormonal treatments cause hypogonadism, event which contributes to the progressive loss of bone mass. This is detectable in patients with breast cancer receiving determines that estrogen-deprivation and in men with prostate cancer with therapies that determine androgen deprivation. Chemotherapy treatments used in cancer patients have reduced bone mass. In addition, low bone mass is detectable in patients with lymphoma treated with corticosteroids or radiation or alkylating agents. In premenopausal patients suffering from breast cancer, treatment with cytotoxic therapy or ablation of ovarian function, can lead to an 8% reduction in bone mineral density at the spine and 4% in the femur. With a chemotherapy regimen in CMF, the reduction of BMD is 6.5%; this bone loss is not recovered after discontinuation of therapy. Tamoxifen given for five years reduces bone remodeling and cause a 32% increase in the risk of osteoporotic fractures when used in premenopausal. After menopause, tamoxifen has a protective effect on bone mass, with a reduced risk of new fractures. Aromatase inhibitors in post-menopausal women, depending on the formulation can cause different effects on the reduction of BMD and fracture risk. We have in fact steroids, exemestane and nonsteroidal, letrozole and anastrozole. Patients at increased risk of fragility fractures should undergo preventive therapies as soon as possible after tests performed for the study of bone health. They can be used DEXA and the FRAX algorithm, which can define a secondary osteoporosis. Prevention and treatment of the increased risk of osteoporotic fracture is to maintain adequate levels of calcium and vitamin D. Bisphosphonates and denosumab are used for the management of bone remodeling and bone loss induced by cancer treatments. Bisphosphonates also have anti-tumor effects per se, which are expressed in potentially prevent the development of bone metastases. In men with metastatic prostate cancer and which is induced androgen deprivation, it is usefully used denosumab 120 mg monthly or zoledronic acid 4 mg monthly.
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Affiliation(s)
- Silva Ottanelli
- Bone Metabolic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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17
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Chen LX, Ning GZ, Zhou ZR, Li YL, Zhang D, Wu QL, Zhang TS, Cheng L, Feng SQ. The carcinogenicity of alendronate in patients with osteoporosis: evidence from cohort studies. PLoS One 2015; 10:e0123080. [PMID: 25881304 PMCID: PMC4399980 DOI: 10.1371/journal.pone.0123080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/27/2015] [Indexed: 01/20/2023] Open
Abstract
Context Alendronate may relate to the incidence of cancers, especially esophageal and colon cancer. But the results are inconsistent in different studies. Objective To quantify the association between the use of alendronate and the occurrence of different types of cancer. Data Sources We searched Embase, Pubmed, CENTRAL, SIGLE and clinicaltrials.gov, up to 2014 June. Study Selection Cohort studies reporting association between alendronate or bisphosphonate therapy including alendronate in patients with osteoporosis and risk of cancer were selected by two authors. Data Extraction Two authors independently extracted the data. The Chi-square test and the I-square test were used for testing heterogeneity between studies. Data Synthesis Eight cohort studies were included in the meta-analysis. Meta-analysis result manifested that alendronate significantly increased the incidence of lung cancer (HR 1.23, 95%CI 1.03 to 1.47, P value = 0.03), nevertheless, there was no significant difference after we excluded either Lee’s 2012 study (HR 1.17, 95%CI 0.95 to 1.44, P value = 0.13) or Chiang’s 2012 study (HR 1.47, 95%CI 1 to 2.17, P value = 0.05). For the incidence of colorectal cancer, no significant difference occurred (HR 0.91, 95%CI 0.74 to 1.13, P value = 0.39), but there was a positive relationship when we used fixed model (HR 0.85, 95%CI 0.78 to 0.93, P value = 0.004). For the incidence of liver cancer, there was no significant difference (HR 1.36, 95%CI 0.9 to 2.04, P value = 0.14), however, the result changed after we excluded Chiang’s 2012 study (HR 1.69, 95%CI 1.03 to 2.77, P value = 0.04). There was no significant difference in other types of cancer. Conclusion Based on current evidences, alendronate therapy may be associated with a high risk of lung cancer, may with an excess risk of liver cancer, a low risk of colorectal and no related risk of other cancers.
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Affiliation(s)
- Ling-Xiao Chen
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People’s Republic of China
| | - Guang-Zhi Ning
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People’s Republic of China
| | - Zhi-Rui Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Yu-Lin Li
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People’s Republic of China
| | - Di Zhang
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People’s Republic of China
| | - Qiu-Li Wu
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People’s Republic of China
| | - Tian-Song Zhang
- Internal Medicine of Traditional Chinese Medicine Department, Jing 'an District Central Hospital of Shanghai, NO. 259, Xikang Road, 200040, Shanghai, People’s Republic of China
| | - Lei Cheng
- Comprehensive Cancer Center of Drum-Tower Hospital, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, People’s Republic of China
| | - Shi-Qing Feng
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People’s Republic of China
- * E-mail:
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18
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Hue TF, Cummings SR, Cauley JA, Bauer DC, Ensrud KE, Barrett-Connor E, Black DM. Effect of bisphosphonate use on risk of postmenopausal breast cancer: results from the randomized clinical trials of alendronate and zoledronic acid. JAMA Intern Med 2014; 174:1550-7. [PMID: 25111880 PMCID: PMC4398333 DOI: 10.1001/jamainternmed.2014.3634] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
IMPORTANCE Studies have shown that bisphosphonates may have antitumor and antimetastatic properties. Recently, observational studies have suggested a possible protective effect of bisphosphonates on breast cancer, but the effect of bisphosphonate use on risk of breast cancer has not been tested in randomized trials. OBJECTIVE To assess the relationship of postmenopausal breast cancer incidence and bisphosphonate use using data from 2 randomized (1:1), double-blind, placebo-controlled trials. DESIGN, SETTING, AND PARTICIPANTS The Fracture Intervention Trial (FIT) randomly assigned 6459 women aged 55 to 81 years to alendronate or placebo for a mean follow-up of 3.8 years. The Health Outcomes and Reduced Incidence With Zoledronic Acid Once Yearly-Pivotal Fracture Trial (HORIZON-PFT) randomly assigned 7765 women aged 65 to 89 years to annual intravenous zoledronic acid or placebo for a mean follow-up of 2.8 years. Data were collected at clinical centers in the United States (FIT and HORIZON-PFT) and in Asia and the Pacific, Europe, North America, and South America (HORIZON-PFT). Women, in either study, with recurrent breast cancer or who reported a history of breast cancer were excluded from analyses. In each trial, a blinded review was conducted of each cancer adverse event report to verify incident invasive breast cancer cases. The primary analysis compared events in the active vs placebo group using a log-rank test. INTERVENTION Alendronate vs placebo (FIT) or zoledronic acid vs placebo (HORIZON-PFT). MAIN OUTCOMES AND MEASURES Hazard ratio for incident breast cancer in the bisphosphonate treatment group compared to the placebo group. RESULTS There was no significant difference in the rate of breast cancer in FIT: 1.5% (n = 46) in the placebo group and 1.8% (n = 57) in the alendronate group (hazard ratio [HR], 1.24 [95% CI, 0.84-1.83]). In HORIZON-PFT, there was also no significant difference: 0.8% (n = 29) in the placebo group and 0.9% (n = 33) in the zoledronic acid group (HR, 1.15 [95% CI, 0.70-1.89]). There was also no significant difference when the data from FIT and HORIZON-PFT were pooled (HR, 1.20 [95% CI, 0.89-1.63]). CONCLUSIONS AND RELEVANCE These 2 randomized clinical trials do not support the findings from observational research. Contrary to the results from observational studies, we found that 3 to 4 years of bisphosphonate treatment did not decrease the risk of invasive postmenopausal breast cancer. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00049829 (HORIZON-PFT).
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Affiliation(s)
- Trisha F Hue
- San Francisco Coordinating Center, Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Steven R Cummings
- San Francisco Coordinating Center, Department of Epidemiology and Biostatistics, University of California, San Francisco2California Pacific Medical Center Research Institute, San Francisco
| | - Jane A Cauley
- Center for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Douglas C Bauer
- San Francisco Coordinating Center, Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Elizabeth Barrett-Connor
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego
| | - Dennis M Black
- San Francisco Coordinating Center, Department of Epidemiology and Biostatistics, University of California, San Francisco
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19
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Watts NB. Long-term risks of bisphosphonate therapy. ACTA ACUST UNITED AC 2014; 58:523-9. [DOI: 10.1590/0004-2730000003308] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 05/12/2014] [Indexed: 12/28/2022]
Abstract
The objective this study was to summarize long-term risks associated with bisphosphonate therapy. Search of relevant medical publications for data from clinical trials, trial extensions, observational studies and post-marketing reports. Trial extensions and modifications did not reveal significant long-term safety issues. Observational data suggest at least as many benefits as risks. Post-marketing reports of musculoskeletal pain, osteonecrosis of the jaw and atypical femur fractures have been widely circulated in the lay press. Most focus on long-terms risks has been on osteonecrosis of the jaw and atypical femur fractures which occur in patients who have not received bisphosphonate therapy but may be more frequent (though still uncommon) in patients who have been on treatment for 5 years or longer. Lower-risk patients may be able to stop treatment after 3-5 years for a “drug holiday,” which mitigates these long-term risks; for higher risk patients, therapy through 6-10 years appears to be advisable and offers more benefits than risks.
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Affiliation(s)
- Nelson B. Watts
- Mercy Health Osteoporosis and Bone Health Services, United States
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20
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Olsen KR, Hansen C, Abrahamsen B. Association between refill compliance to oral bisphosphonate treatment, incident fractures, and health care costs--an analysis using national health databases. Osteoporos Int 2013; 24:2639-47. [PMID: 23604250 DOI: 10.1007/s00198-013-2365-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 03/27/2013] [Indexed: 12/19/2022]
Abstract
SUMMARY The study estimates the cost of poor and suboptimal refill compliance by estimating fracture costs and assessing the association between refill compliance with oral bisphosphonates and incident fractures using Danish health registers. Patients with poor and suboptimal refill compliance had more major osteoporotic fractures, and the direct costs related to hospital care, primary care, and pharmaceutical treatment for these excess fractures reached almost 14 M DKK (2.5 M USD) for the study population which compares to a national annual excess cost of around 17 M DKK (3.1 M USD) using 2011 prescription prevalence. INTRODUCTION Adherence to oral anti-osteoporosis treatment has been shown in several studies to be relatively low and the potential impact on fracture burden is high. The aim of the study was to assess the association between refill compliance and all-cause health care costs. METHODS A national dataset was extracted with all treatment-naive patients who began oral bisphosphonate (BP) treatment for osteoporosis in Denmark between 1997 and 2006 (N = 54,876, 87 % women). Patients who survived for at least 2 years (N = 47,176) were divided into groups based on Medication Possession Ratio (MPR). Logistic regressions were used to derive difference in the probability of incident fractures between the three MPR groups. Fracture costs (related to medication use, primary care practice, specialists, and hospitals) were derived by comparing cost 12 months before and after fracture. RESULTS For alendronate, the adjusted risk of major osteoporotic fractures was significantly reduced (OR 0.768; 0.686-0.859), including fractures of the hip (0.718; 0.609-0.846) and humerus (0.54; 0.431-0.677) with MPR ≥ 0.8. The risk reduction was lower with etidronate. Over 2 years, a total of 171 hip fractures and 53 other major osteoporotic fractures were attributed to suboptimal or poor refill compliance, with an excess cost of 13.7 M DKK (2.5 M USD). CONCLUSIONS Poor refill compliance is not unusual in patients on oral bisphosphonates, and we demonstrate that this is accompanied by excess major osteoporotic fractures and health care costs at the societal level.
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Affiliation(s)
- K R Olsen
- GSK Pharma A/S, Nykær 68, 2605, Broendby, Denmark
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21
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Vinogradova Y, Coupland C, Hippisley-Cox J. Exposure to bisphosphonates and risk of common non-gastrointestinal cancers: series of nested case-control studies using two primary-care databases. Br J Cancer 2013; 109:795-806. [PMID: 23868009 PMCID: PMC3738131 DOI: 10.1038/bjc.2013.383] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 06/05/2013] [Accepted: 06/11/2013] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Bisphosphonates are the most commonly prescribed osteoporosis drugs but long-term effects are unclear, although antitumour properties are known from preclinical studies. METHODS Nested case-control studies were conducted to investigate bisphosphonate use and risks of common non-gastrointestinal cancers (breast, prostate, lung, bladder, melanoma, ovarian, pancreas, uterus and cervical). Patients 50 years and older, diagnosed with primary cancers between 1997 and 2011, were matched to five controls using the UK practice-based QResearch and Clinical Practice Research Datalink (CPRD) databases. The databases were analysed separately and the results combined. RESULTS A total of 91 556 and 88 845 cases were identified from QResearch and CPRD, respectively. Bisphosphonate use was associated with reduced risks of breast (odds ratio (OR): 0.92, 95% confidence interval (CI): 0.87-0.97), prostate (OR: 0.87, 95% CI: 0.79-0.96) and pancreatic (OR: 0.79, 95% CI: 0.68-0.93) cancers in the combined analyses, but no significant trends with duration. For alendronate, reduced risk associations were found for prostate cancer in the QResearch (OR: 0.81, 95% CI: 0.70-0.93) and combined (OR: 0.84, 95% CI: 0.75-0.93) analyses (trend with duration P-values 0.009 and 0.001). There were no significant associations from any of the other analyses. CONCLUSION In this series of large population-based case-control studies, bisphosphonate use was not associated with increased risks for any common non-gastrointestinal cancers.
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Affiliation(s)
- Y Vinogradova
- Division of Primary Care, University Park, Nottingham NG2 7RD, UK.
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22
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Reginster JY, Pelousse F, Bruyère O. Safety concerns with the long-term management of osteoporosis. Expert Opin Drug Saf 2013; 12:507-22. [PMID: 23614635 DOI: 10.1517/14740338.2013.793669] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Postmenopausal osteoporosis is a chronic disease that exerts a significant burden on both individuals and the community. Hence, there is a requirement for long-term treatment to be associated with a positive benefit-risk balance. AREAS COVERED In this descriptive review, the long-term safety of calcitonin, selective estrogen receptor modulators (SERMs), bisphosphonates, denosumab and strontium ranelate was reviewed based on randomized controlled trials of 3 years or longer supplemented by extension study data and data from large, observational studies. EXPERT OPINION Rare adverse events become apparent with all currently available treatments for osteoporosis with long-term therapy. Due to the rarity of these adverse events and to the worldwide burden of osteoporosis, the benefit-risk balance remains in favor of the beneficial effects of treatment on an outcome rather than the probability of an adverse effect. No single antiosteoporosis agent is appropriate for all patients. Treatment decisions should be made on an individual basis, taking into account the relative benefits and risks in different patient populations.
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Affiliation(s)
- Jean-Yves Reginster
- University of Liège, Department of Public Health and Health Economics, Liège, Belgium.
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23
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Lankarani KB. Bisphosphonates and colon cancer. Osteoporos Int 2013; 24:1139-40. [PMID: 22810919 DOI: 10.1007/s00198-012-2078-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 06/28/2012] [Indexed: 02/05/2023]
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24
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Lee WY, Sun LM, Lin MC, Liang JA, Chang SN, Sung FC, Muo CH, Kao CH. A higher dosage of oral alendronate will increase the subsequent cancer risk of osteoporosis patients in Taiwan: a population-based cohort study. PLoS One 2012; 7:e53032. [PMID: 23300854 PMCID: PMC3534103 DOI: 10.1371/journal.pone.0053032] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 11/22/2012] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Controversy still exists regarding whether alendronate (ALN) use increases the risk of esophageal cancer or breast cancer. METHODS This paper explores the possible association between the use of oral ALN in osteoporosis patients and subsequent cancer risk using the National Health Insurance (NHI) system database of Taiwan with a Cox proportional-hazard regression analysis. The exposure cohort contained 5,624 osteoporosis patients used ALN and randomly frequency-matched by age and gender of 3 osteoporosis patients without any kind of anti-osteoporosis drugs in the same period. RESULTS For a dose ≥ 1.0 g/year, the risk of developing overall cancer was significantly higher (hazard ratio: 1.69, 95% confidence ratio: 1.39-2.04) than in osteoporosis patients without any anti-osteoporosis drugs. The risks for developing liver, lung, and prostate cancers and lymphoma were also significantly higher than in the control group. CONCLUSIONS This population-based retrospective cohort study did not find a relationship between ALN use and either esophageal or breast cancer, but unexpectedly discovered that use of ALN with dose ≥ 1.0 g/year significantly increased risks of overall cancer incidence, as well as liver, lung, and prostate cancers and lymphoma. Further large population-based unbiased studies to enforce our findings are required before any confirmatory conclusion can be made.
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Affiliation(s)
- Wen-Yuan Lee
- China Medical University Hospital Taipei Branch, Taipei, Taiwan
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Li-Min Sun
- Department of Radiation Oncology, Zuoying Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Ming-Chia Lin
- Department of Nuclear Medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Ji-An Liang
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Ph.D. Program for Cancer Biology and Drug Discovery, China Medical University, Taichung, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Institute of Environmental Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
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25
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Abstract
Bisphosphonates are widely used in the treatment of osteoporosis to reduce fracture risk. Because of their long retention time in bone and uncommon side effects, questions have been raised about the optimal duration of therapy. Potential side effects appear to be rare and may not be causally related. Although there is no strong science to guide "drug holidays," there appears to be some lingering antifracture benefit when treatment is stopped, so some time off treatment should be offered to most patients on long-term bisphosphonate therapy. For most patients with osteoporosis, the benefits of treatment outweigh the risks.
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Affiliation(s)
- Dima L Diab
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Cincinnati VA Medical Center, University of Cincinnati, 3125 Eden Avenue, PO Box 670547, Cincinnati, OH 45267, USA.
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26
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Bisphosphonate Use and the Risk of Breast Cancer: A Meta-Analysis of Published Literature. Clin Breast Cancer 2012; 12:276-81. [DOI: 10.1016/j.clbc.2012.04.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 03/06/2012] [Accepted: 04/12/2012] [Indexed: 11/24/2022]
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27
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Vinogradova Y, Coupland C, Hippisley-Cox J. Exposure to bisphosphonates and risk of cancer: a protocol for nested case-control studies using the QResearch primary care database. BMJ Open 2012; 2:e000548. [PMID: 22240651 PMCID: PMC3278492 DOI: 10.1136/bmjopen-2011-000548] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction Bisphosphonates are becoming a common treatment for osteoporosis particularly after discovery of the association between hormone replacement therapy and increased risk of breast cancer. As osteoporosis develops with age, treatment is a long-term intervention. Randomised control trials typically have limited follow-up times, which restricts investigation of the effects of the drugs on risk of primary cancers. A few observational studies have demonstrated a reduced risk of breast cancer and possibly of endometrial cancer in bisphosphonate users. Two epidemiological studies have studied the effect of the drugs on oesophageal cancer but did not reach any definite conclusions. So far, no effects on colorectal and stomach cancer have been shown. This study will investigate the association of bisphosphonates with risks of the 10 most common primary cancers. Methods and analysis A series of nested case-control studies will be based on the general population using records from 660 UK general practices within the QResearch Database. Cases will be patients with primary cancers diagnosed between 1996 and 2011. Each case will be matched by age, sex, practice and calendar year to five controls, who are alive and registered with the practice at the time of diagnosis of the case. Exposure to bisphosphonates will be defined as at least one prescription during the study period. For the most common cancers with substantial numbers of observations, the effect of the duration of the treatment and different types of bisphosphonates will be studied. Conditional logistic regression will be applied to produce ORs adjusted for smoking status, socioeconomic status, ethnicity, cancer-specific co-morbidities and use of other medications.
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Affiliation(s)
- Yana Vinogradova
- Division of Primary Care, University of Nottingham, School of Community Health Sciences, Division of Primary Care, University Park, Nottingham, UK
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28
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Monsees GM, Malone KE, Tang MTC, Newcomb PA, Li CI. Bisphosphonate use after estrogen receptor-positive breast cancer and risk of contralateral breast cancer. J Natl Cancer Inst 2011; 103:1752-60. [PMID: 22021667 DOI: 10.1093/jnci/djr399] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A growing body of evidence suggests that nitrogenous bisphosphonates may reduce the risk of developing a first breast cancer and may prevent metastases among breast cancer survivors. However, their impact on risk of second primary contralateral breast cancer is uncertain. METHODS Within a nested case-control study among women diagnosed with a first primary estrogen receptor-positive invasive breast cancer at ages 40-79 years, we assessed the association between post-diagnostic bisphosphonate use and risk of second primary contralateral breast cancer. We used multivariable-adjusted conditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) comparing 351 contralateral breast cancer case subjects with 662 control subjects (ie, breast cancer patients not diagnosed with contralateral breast cancer) who were incidence density-matched on county; race/ethnicity; and age at, year of, and stage at first breast cancer diagnosis. We performed sensitivity analyses with respect to bisphosphonate type and confounding by indication. All statistical tests were two-sided. RESULTS Current use of any nitrogenous bisphosphonate and use specifically of alendronate were both associated with reduced risks of contralateral breast cancer compared with never use (OR = 0.41, 95% CI = 0.20 to 0.84 and OR = 0.39, 95% CI = 0.18 to 0.88, respectively). The risk of contralateral breast cancer further declined with longer durations of bisphosphonate use among current users (P(trend) = .03). Results were similar in analyses restricted to patients with a history of osteoporosis or osteopenia. CONCLUSIONS Bisphosphonate use was associated with a substantial reduction in risk of contralateral breast cancer. If this finding is confirmed in additional studies, nitrogenous bisphosphonate therapy may be a feasible approach for contralateral breast cancer risk reduction.
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Affiliation(s)
- Genevieve M Monsees
- SD, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
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