Oral alendronate use and risk of cancer in postmenopausal women with osteoporosis: A nationwide study

Authors

  • Chia-Hung Chiang,

    1. Division of Cardiology, Department of Medicine, Zhudong Veterans Hospital, HsinChu, Taiwan
    2. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    3. Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
    4. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Chin-Chou Huang,

    1. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
    3. Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
    4. Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
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  • Wan-Leong Chan,

    1. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
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    • WLC and HBL contributed equally to this work.

  • Po-Hsun Huang,

    1. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
    3. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Tzeng-Ji Chen,

    1. Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
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  • Chia-Min Chung,

    1. Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
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  • Shing-Jong Lin,

    1. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
    3. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
    4. Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Jaw-Wen Chen,

    1. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
    3. Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
    4. Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
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  • Hsin-Bang Leu

    Corresponding author
    1. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
    3. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
    4. Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
    • Healthcare and Management Center, Division of Cardiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei, Taiwan, R.O.C.
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    • WLC and HBL contributed equally to this work.


Abstract

The association between use of oral bisphosphonates and cancer development in elderly women is still uncertain, and previous studies have shown controversial results. We used a nationwide, population-based database to explore the relationship between the use of alendronate, an oral bisphosphonate agent used for the treatment of osteoporosis, and the risk of all malignancies in women with osteoporosis and age over 55 years. In the study group, we included 6906 women with osteoporosis (age, mean ± SD, 73.4 ± 8.4 years) taking oral alendronate, who were selected from a 1,000,000 sample cohort dataset collected between January 1998 and December 2009. Another 20,697 age- and comorbidity-matched women (73.5 ± 8.4 years) without bisphosphonates treatment were included in the control group. No subjects had any history of being diagnosed with cancer before inclusion. We used a log-rank test to analyze the differences in accumulated cancer-free survival rates between these two groups. A Cox proportional-hazard model, adjusted for confounding factors, was used to evaluate the association between alendronate use and the development of all cancer events in postmenopausal women with osteoporosis. During the mean follow-up period of 4.8 years, 821 patients from the study group and 2646 patients from the control group had new cancers. There was no significant difference in cancer incidence between alendronate users and controls (11.9% versus 12.8%, p = 0.054). The person-year incidence of newly-developed cancer in alendronate users and controls was 28.0 and 29.4 per 1000 person-years, respectively. Alendronate use was not associated with increased risk of cancer development in women with osteoporosis (adjusted hazard ratio, 1.05; 95% confidence interval [CI], 0.97–1.13; p = 0.237). However, due to the limited study size and underpowered results, further larger prospective studies or meta-analysis are suggested to further confirm our findings. © 2012 American Society for Bone and Mineral Research.

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