Monday, February 11, 2013

[47] Are bisphosphonates associated with an increased risk of GI cancers?

Bisphosphonates not associated with increased risk of GI cancers #MP111212
[Vinogradova, BMJ, 2013, bisphosphonates, GI cancer, adjusted odds ratio]

BMJ. 2013 Jan 16;346:f114. doi: 10.1136/bmj.f114.
Exposure to bisphosphonates and risk of gastrointestinal cancers: series
of nested case-control studies with QResearch and CPRD data.
Vinogradova Y, Coupland C, Hippisley-Cox J.
Division of Primary Care, University Park, Nottingham NG2 7RD, UK.
To investigate the association between use of bisphosphonates estimated
from prescription information and risk of gastrointestinal cancers.
Series of nested case-control studies.
General practices in the United Kingdom contributing to the QResearch
primary care database (660) and the Clinical Practice Research Datalink
(CPRD) (643).
Patients aged ≥50 with a diagnosis of a primary gastrointestinal cancer
in 1997-2011, each matched with up to five controls by age, sex,
practice, and calendar year.
Odds ratios for incident gastrointestinal cancers (colorectal,
oesophageal, gastric) and use of bisphosphonates, adjusted for smoking
status, ethnicity, comorbidities, and use of other drugs.
20 106 and 19 035 cases of colorectal cancer cases, 5364 and 5135 cases
of oesophageal cancer cases, and 3155 and 3157 cases of gastric cancer
were identified from QResearch and CPRD, respectively. Overall
bisphosphonate use (at least one prescription) was not associated with
risk of colorectal, oesophageal, or gastric cancers in either database.
Adjusted odds ratios (95% confidence interval) for QResearch and CPRD
were 0.97 (0.79 to 1.18) and 1.18 (0.97 to 1.43) for oesophageal cancer;
1.12 (0.87 to 1.44) and 0.79 (0.62 to 1.01) for gastric cancer; and 1.03
(0.94 to 1.14) and 1.10 (1.00 to 1.22) for colorectal cancer. Additional
analyses showed no difference between types of bisphosphonate for risk
of oesophageal and colorectal cancers. For gastric cancer, alendronate
use was associated with an increased risk (1.47, 1.11 to 1.95; P=0.008),
but only in data from the QResearch database and without any association
with duration and with no definitive confirmation from sensitivity analysis.
In this series of population based case-control studies in two large
primary care databases, exposure to bisphosphonates was not associated
with an increased risk of common gastrointestinal cancers.
PMID: 23325866 [PubMed - in process] PMCID: PMC3546625 Free PMC Article

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