Authors: P Vestergaard K Schwartz E M Pinholt L Rejnmark L Mosekilde
Publish Date: 2010/05/07
Volume: 22, Issue: 4, Pages: 1037-1045
Abstract
Prior studies have associated fatal stroke with raloxifene In a cohort study we found no excess risk of stroke with raloxifene whereas an excess risk of stroke and fatal stroke was seen with alendronate and etidronate However the excess risks were smallThis is a nationwide cohort study from Denmark All users of bisphosphonates and other drugs against osteoporosis between 1996 and 2006 n = 103562 as exposed group and three age and gendermatched controls from the general population n = 310683Before the drugs were started patients later initiating alendronate or raloxifene had fewer strokes than the controls In contrast patients who later did start clodronate have more strokes Among the later users of other bisphosphonates strontium ranelate or parathyroid hormone no change in the risk of stroke was present Patients who started raloxifene neither had an excess risk of strokes nor of fatal strokes No dose–response relationship was present Among users of alendronate a decreasing overall risk of stroke was seen with increasing dose However for fatal strokes the risk increased with increasing dose of alendronate Among users of etidronate no trend with dose was present for overall stroke risk whereas for fatal strokes an increasing risk was seen with increasing dose of etidronateRaloxifene does not seem associated with an excess risk of strokes The increase seen for alendronate did not seem to be causal as no classical dose–response relationship was present The dose–response relationship for fatal strokes with alendronate and etidronate needs further examination However the excess risks were small and may be due to the underlying disease
Keywords: