Authors: G Breart C Cooper O Meyer C SPEIrs N Deltour J Y Reginster
Publish Date: 2009/10/06
Volume: 21, Issue: 7, Pages: 1181-1187
Abstract
In a retrospective cohort study using the General Practice Research Database GPRD there was a greater association of venous thromboembolism VTE in osteoporotic than in nonosteoporotic female patients No greater association was shown in treated patients with strontium ranelate or alendronate compared to untreated osteoporotic female patientsA retrospective study was conducted using the GPRD in the UK The cohorts consisted of untreated osteoporotic women N = 11546 osteoporotic women treated with alendronate N = 20084 or strontium ranelate N = 2408 and a sample of nonosteoporotic women N = 115009 Cohorts were compared using a Cox proportional hazards regression modelThere was a significantly increased relative risk for VTE in untreated osteoporotic women versus nonosteoporotic women annual incidence 56 and 32 per 1000 patient–years respectively relative risk 175 95 confidence interval CI 109–184 Results were confirmed using adjusted models The annual incidences of VTE in osteoporotic patients treated with strontium ranelate and alendronate were 70 and 72 per 1000 patient–years respectively with no significant difference between untreated and treated patients whatever the treatment Adjusted hazard ratios for treated versus untreated osteoporotic women were 109 95 CI 060–201 for strontium ranelate and 092 95 CI 063–133 for alendronateThe incidence of venous thromboembolism VTE varies according to the presence of a number of risk factors most notable are age immobilisation hospitalisation and surgery 1 2 In addition ageing is accompanied by an increasing incidence of chronic diseases which can impair general health status and may also indirectly increase the risk for VTE 3 One such chronic disease is osteoporosis which leads to an increased risk for fracture especially when it is associated with other risk factors such as age sex history of fractures low body mass index BMI or a recent fall 4 5 6 The occurrence of osteoporotic fracture may in turn lead to immobilisation hospitalisation and surgery By accumulating risk factors ageing osteoporotic patients may therefore be particularly susceptible to VTE though this has never been demonstratedThe most commonly used agents to treat osteoporosis are bisphosphonates calcitonin raloxifene parathyroid hormone and strontium ranelate 7 8 9 10 Analyses of the pooled populations of phase III studies for strontium ranelate have shown a slight increase in the annual incidence of VTE with a relative risk of 14 95 confidence interval CI 10–20 versus placebo 11 However this increased risk with strontium ranelate remains weak when compared with treatments with a clear biological rationale for increasing VTE such as selective oestrogen–receptor modulators or oestrogen replacement treatment 12 13 14 15The objectives of this study were to explore the incidence of VTE and its risk factors in osteoporotic and nonosteoporotic women and to investigate the relationship between the incidence of VTE and the antiosteoporotic treatments strontium ranelate and alendronate sodium Alendronate sodium is the most highly prescribed bisphosphonate in the UK and has never been associated with an increased risk for VTE
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