April 28, 2008
Osteoporosis drug Fosamax linked to heart problem
Finding from Group Health and University of Washington study
Seattle—Women who have used Fosamax are nearly twice as likely to
develop the most common kind of chronically irregular heartbeat (atrial
fibrillation) than are those who have never used it, according to research
from Group Health and the University of Washington published in the April 28
Archives of Internal Medicine.
Merck markets Fosamax, the most widely used drug treatment for the
bone-thinning disease osteoporosis, explained study leader Susan Heckbert,
MD, PhD, MPH, a professor of epidemiology and scientific investigator in the
Cardiovascular Health Research Unit at the University of Washington. The
Food and Drug Administration (FDA) approved the first generic versions
(called alendronate) in February.
“We studied more than 700 female Group Health patients whose atrial
fibrillation was first detected during a three-year period,” said Dr.
Heckbert. She and her colleagues compared those women to over 900 randomly
selected female Group Health members matched on age and high blood pressure
to serve as controls.
“Having ever used alendronate was associated with an 86 percent higher
risk of newly detected atrial fibrillation compared with never having used
the drug,” said Dr. Heckbert, who is also an affiliate investigator at the
Group Health Center for Health Studies.
Osteoporosis mostly affects older women and can set the stage for
fractures that can impair the quality of their lives, said Dr. Heckbert.
“Careful judgment is required to weigh the risks and benefits of any
medication for any individual patient,” she added. “For most women at high
risk of fracture, alendronate’s benefit of reducing fractures will outweigh
the risk of atrial fibrillation.”
However, said Dr. Heckbert, “women who are at high risk of
fractures but also have risk factors for atrial fibrillation—such as heart
failure, diabetes, or coronary disease—might want to discuss alternatives to
alendronate with their health care providers.” Other medications that can
lower the risk of fractures include estrogen, she said. But the Women’s
Health Initiative, on which she has also served as an investigator, showed
other heart risks from hormone therapy combining estrogen with progesterone.
The National Heart, Lung, and Blood Institute funds Dr. Heckbert’s Atrial
Fibrillation Study, which collects data on all Group Health patients as they
are first diagnosed with atrial fibrillation. The study aims to find new
factors that raise the risk of developing this quivering of the heart’s
upper chambers (atria).
About one in 100 people—and nearly nine in 100 people over age 80—have
atrial fibrillation, said Dr. Heckbert. In many cases, atrial fibrillation
has no symptoms, and it isn’t necessarily life threatening. But it can cause
palpitations, fainting, fatigue, or congestive heart failure.
Atrial fibrillation can also make blood pool—and sometimes clot—in the
atria, said Dr. Heckbert. When parts of clots break off and leave the atria,
they can lead to embolic strokes, as happens in over 70,000 Americans a
year. That’s why atrial fibrillation is often treated with the anticoagulant
warfarin. Other results from her study have suggested that maintaining a
healthy body weight may help protect people from atrial fibrillation.
“This study will help medical teams better inform their patients about
the risks associated with Fosamax, helping us make the best treatment
decisions for managing osteoporosis,” commented Christine Himes Fordyce, MD,
a Group Health family practitioner. “Now with this increased understanding
of potential irregular heartbeats, both physicians and their patients
should be alert to any problems, report them immediately, and treat them
appropriately.”
About Group Health Center for Health Studies
Founded in 1947, Group Health is a Seattle-based, consumer-governed,
nonprofit health care system that coordinates care and coverage. For 25
years, Group Health Center for Health Studies has conducted research on
preventing, diagnosing, and treating major health problems. Government and
private research grants provide its main funding.
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