ArticleBMJ (Clinical research ed.)2010
Oral bisphosphonates and risk of cancer of oesophagus, stomach, and colorectum: case-control analysis within a UK primary care cohort.
Article in BMJ (Clinical research ed.), 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 95 papers, 9 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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
95 citing papers in PubMed, 9 syntheses or guidelines pooled it, 277 citations in OpenAlex.
- Bisphosphonates and risk of cancers: a systematic review and meta-analysis.British journal of cancer · 2020Pooled it
- European guidance for the diagnosis and management of osteoporosis in postmenopausal women.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2019Guideline
- Bisphosphonates and evidence for association with esophageal and gastric cancer: a systematic review and meta-analysis.BMJ open · 2015Pooled it
- The carcinogenicity of alendronate in patients with osteoporosis: evidence from cohort studies.PloS one · 2015Pooled it
- Bisphosphonate use and risk of colorectal cancer: a systematic review and meta-analysis.British journal of clinical pharmacology · 2013Pooled it
- Bisphosphonate treatment and risk of esophageal cancer: a meta-analysis of observational studies.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2013Pooled it
- European guidance for the diagnosis and management of osteoporosis in postmenopausal women.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2013Guideline
- Bisphosphonate use and gastrointestinal tract cancer risk: meta-analysis of observational studies.World journal of gastroenterology · 2012Pooled it
- 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2010Guideline
- Whole Body Vibration Exposure on Markers of Bone Turnover, Body Composition, and Physical Functioning in Breast Cancer Patients Receiving Aromatase Inhibitor Therapy: A Randomized Controlled Trial.Integrative cancer therapies · 2018Trial
- Assessing the feasibility of the Effectiveness of Discontinuing Bisphosphonates trial: a pilot study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2017Trial
- Oral bisphosphonates and colorectal cancer.Scientific reports · 2017Trial
- Effect of 6 months of whole body vibration on lumbar spine bone density in postmenopausal women: a randomized controlled trial.Clinical interventions in aging · 2013Trial
- Analytic Misjudgment of Drug Safety Evidence and Causality: From the Prosecutor's Fallacy and Simpson's Paradox to Artificial Intelligence.Drug safety · 2026Review
- Oral Bisphosphonates for Colorectal Cancer Prevention: A Meta-Analytic Reappraisal Beyond Bone Health.Journal of clinical medicine · 2025Review
- The necessity of validity diagnostics when drawing causal inferences from observational data: lessons from a multi-database evaluation of the risk of non-infectious uveitis among patients exposed to RemicadeBMC medical research methodology · 2024Article
- Article
- Medication-related osteonecrosis of the jaw (MRONJ): a review of pathogenesis hypothesis and therapy strategies.Archives of toxicology · 2024Review
- Disproportionality analysis of oesophageal toxicity associated with oral bisphosphonates using the FAERS database (2004-2023).Frontiers in pharmacology · 2024Article
- Can locally applied risedronate be an effective agent when combined with xenografts? An animal study.BMC oral health · 2023Article
35 more citing papers are in PubMed but not listed here.
Corrections and comments
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- Commented on by[Not Available].2012
Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
Abstract
objectiveTo examine the hypothesis that risk of oesophageal, but not of gastric or colorectal, cancer is increased in users of oral bisphosphonates.
designNested case-control analysis within a primary care cohort of about 6 million people in the UK, with prospectively recorded information on prescribing of bisphosphonates.
settingUK General Practice Research Database cohort.
participantsMen and women aged 40 years or over-2954 with oesophageal cancer, 2018 with gastric cancer, and 10 641 with colorectal cancer, diagnosed in 1995-2005; five controls per case matched for age, sex, general practice, and observation time.
main outcome measuresRelative risks for incident invasive cancers of the oesophagus, stomach, and colorectum, adjusted for smoking, alcohol, and body mass index.
resultsThe incidence of oesophageal cancer was increased in people with one or more previous prescriptions for oral bisphosphonates compared with those with no such prescriptions (relative risk 1.30, 95% confidence interval 1.02 to1.66; P=0.02). Risk of oesophageal cancer was significantly higher for 10 or more prescriptions (1.93, 1.37 to 2.70) than for one to nine prescriptions (0.93, 0.66 to 1.31) (P for heterogeneity=0.002), and for use for over 3 years (on average, about 5 years: relative risk v no prescription, 2.24, 1.47 to 3.43). Risk of oesophageal cancer did not differ significantly by bisphosphonate type, and risk in those with 10 or more bisphosphonate prescriptions did not vary by age, sex, smoking, alcohol intake, or body mass index; by diagnosis of osteoporosis, fracture, or upper gastrointestinal disease; or by prescription of acid suppressants, non-steroidal anti-inflammatory drugs, or corticosteroids. Cancers of the stomach and colorectum were not associated with prescription of bisphosphonate: relative risks for one or more versus no prescriptions were 0.87 (0.64 to 1.19) and 0.87 (0.77 to 1.00). The specificity of the association for oesophageal cancer argues against methodological problems in the selection of cases and controls or in the analysis.
conclusionsThe risk of oesophageal cancer increased with 10 or more prescriptions for oral bisphosphonates and with prescriptions over about a five year period. In Europe and North America, the incidence of oesophageal cancer at age 60-79 is typically 1 per 1000 population over five years, and this is estimated to increase to about 2 per 1000 with five years' use of oral bisphosphonates.
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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.