A large meta-analysis of nine studies showed that both oral and IV bisphosphonates were associated with a significantly increased risk of new-onset atrial-fibrillation (AF). The analysis also showed that the risk was greater with the IV drugs.

According to the lead author, Dr Abhishek Sharma (Maimonides Medical Center, Brooklyn, NY.) the meta-analysis suggests that bisphosphonates should be continued as a first-line therapy for osteoporosis and osteopenia, “but we should be very careful in selecting our patients.”  He indicated that patients at high risk for AF, those who are older or have a history of cardiac events should be closely monitored.  He acknowledged that bisphosphonate therapy has been shown to reduce morbidity and mortality.

“Bisphosphonates are very commonly used medications, and more and more indications are coming up, and these patients tend to have concomitant cardiac conditions,” Sharma pointed out. “Bisphosphonates are usually started by the patient’s general physician or oncologist. I strongly suggest that my cardiology colleagues should be aware of this association, and apart from close patient surveillance, they should work with oncologists.”

The meta-analysis was published online March 15, 2014, in the American Journal of Cardiology.

Despite this, in 2008 the FDA reviewed some literature and determined that there is not a link between bisphosphonate usage and AF.  Some of the studies used in the latest analysis were performed after the decision from the FDA, so their determination should be re-considered.

Joel T. Nowak, M.A., M.S.W.