ArticlePloS one2009
Oral bisphosphonates and risk of atrial fibrillation and flutter in women: a self-controlled case-series safety analysis.
Article in PloS one, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 3 syntheses or guidelines pooled it, 68 citations in OpenAlex.
- Cardiovascular Safety and Effectiveness of Bisphosphonates: From Intervention Trials to Real-Life Data.Nutrients · 2022Pooled it
- Alendronate and atrial fibrillation: a meta-analysis of randomized placebo-controlled clinical trials.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2012Pooled it
- Bisphosphonates and risk of atrial fibrillation: a meta-analysis.Arthritis research & therapy · 2010Pooled it
- Underlying Mechanisms of Osteoporosis in the Context of Multimorbidity: Clinical Challenges and Management Strategies.Nutrients · 2026Review
- Selecting the most informative positive and negative controls for self-controlled case series (SCCS): Rationale, approach, and lessons from studies investigating the safety of COVID-19 vaccines.Journal of global health · 2024Article
- The Association between Treatment with Bisphosphonates and the Risk of Atrial Fibrillation: A Meta-Analysis of Observational Studies.Korean journal of family medicine · 2022Article
- Bisphosphonates and cardiovascular risk in elderly patients with previous cardiovascular disease: a population-based nested case-control study in Italy.Therapeutic advances in drug safety · 2019Article
- Acute effect of zoledronic acid on the risk of cardiac dysrhythmias.Internal and emergency medicine · 2015Article
- Efficacy of zoledronic acid in treatment of osteoporosis in men and women-a meta-analysis.International journal of clinical and experimental medicine · 2015Article
- Defining disease phenotypes using national linked electronic health records: a case study of atrial fibrillation.PloS one · 2014Article
- Does design matter? Systematic evaluation of the impact of analytical choices on effect estimates in observational studies.Therapeutic advances in drug safety · 2013Article
- Arrhythmias during and after zoledronic acid infusion patients with bone metastasis.Medical oncology (Northwood, London, England) · 2013Article
- Heart failure as a risk factor for osteoporosis and fractures.Current osteoporosis reports · 2012Review
- Drug-induced atrial fibrillation.Drugs · 2012Review
- Intravenous bisphosphonate therapy and atrial fibrillation/flutter risk in cancer patients: a nationwide cohort study.British journal of cancer · 2011Article
- A self-controlled case series to assess the effectiveness of beta blockers for heart failure in reducing hospitalisations in the elderly.BMC medical research methodology · 2011Article
- Predictors of incident atrial fibrillation and influence of medications: a retrospective case-control study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2011Article
- Oral bisphosphonates and risk of ischemic stroke: a case-control study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2011Article
- Use of the self-controlled case series method in drug safety assessment.Expert opinion on drug safety · 2011Article
- Review
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundA recent trial unexpectedly reported that atrial fibrillation, when defined as serious, occurred more often in participants randomized to an annual infusion of the relatively new parenteral bisphosphonate, zoledronic acid, than among those given placebo, but had limited power. Two subsequent population-based case-control studies of patients receiving a more established oral bisphosphonate, alendronic acid, reported conflicting results, possibly due to uncontrolled confounding factors. METHODOLOGY/PRINCIPAL
findingsWe used the United Kingdom General Practice Research Database to assess the risk of atrial fibrillation and flutter in women exposed to the oral bisphosphonates, alendronic acid and risedronate sodium. The self-controlled case-series method was used to minimise the potential for confounding. The age-adjusted incidence rate ratio for atrial fibrillation or flutter in individuals during their exposure to these oral bisphosphonates (n = 2195) was 1.07 (95% CI 0.94-1.21). The age-adjusted incidence rate ratio for alendronic acid (n = 1489) and risedronate sodium (n = 649) exposed individuals were 1.09 (95% CI 0.93-1.26) and 0.99 (95% CI 0.78-1.26) respectively. In post-hoc analyses, an increased risk of incident atrial fibrillation or flutter was detected for patients during their first few months of alendronic acid therapy. CONCLUSIONS/SIGNIFICANCE: We found no robust evidence of an overall long-term increased risk of atrial fibrillation or flutter associated with continued exposure to the oral bisphosphonates, alendronic acid and risedronate sodium. A possible signal for an increase in risk during the first few months of therapy with alendronic acid needs to be re-assessed in additional studies.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.