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Article: Bisphosphonates and atrial fibrillation: Bayesian meta-analyses of randomized controlled trials and observational studies

TitleBisphosphonates and atrial fibrillation: Bayesian meta-analyses of randomized controlled trials and observational studies
Authors
Issue Date2009
PublisherBioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcmusculoskeletdisord/
Citation
Bmc Musculoskeletal Disorders, 2009, v. 10 n. 1 How to Cite?
AbstractBackground. Occurrence of atrial fibrillation (AF) amongst bisphosphonate users has been increasingly reported but results are conflicting. We performed a Bayesian meta-analysis to address the possible association between the occurrence of AF and bisphosphonate use and estimated the posterior probability of development of AF with bisphosphonate use. Methods. Randomized controlled trials (RCTs) evaluating the efficacy and safety of bisphosphonates for treating and preventing osteoporosis, and observational studies investigating the incidence of AF amongst bisphosphonate users, were searched in electronic databases. We pooled the effect size with Bayesian meta-analysis for odds ratio (OR) and calculated its posterior probability of development of AF in bisphosphonate users for RCTs and observational studies, reported with the 95% credible interval (CI). Results. Of 1751 potentially relevant citations initially retrieved, 4 RCTs and 2 reports of RCTs, and 3 observational studies were included for this meta-analysis. On pooling the RCTs, there was a non-significantly higher risk of overall (OR 1.184, 95% CI 0.837-1.656) and serious AF (OR 1.590, 95% CI 0.613-3.751) in bisphosphonate-treated patients. Combining data of observational studies also revealed a non-significantly higher risk of AF in bisphosphonate users (OR 1.251, 95% CI 0.980-1.732). Using Bayesian meta-analysis based on the effect size of observational studies as the prior, the posterior probability of OR1.2 in the development of AF amongst bisphosphonate users in the RCTs was 0.484. Egger's regression demonstrated no notable publication bias in all the analyses. Conclusion. The current meta-analysis revealed no evidence of a higher risk of AF associated with bisphosphonate use. Nevertheless, based on Bayesian meta-analysis with the effect size of the observational studies as the prior, the posterior probabilities of development of AF was found to be 0.484 if the risk of AF was estimated to be more than 20%. The results of the current meta-analysis thus offer clinicians the practical probability of development of AF in patients who take bisphosphonates for the treatment of bone loss and corticosteroid induced osteoporosis. © 2009 Mak et al.
Persistent Identifierhttp://hdl.handle.net/10722/163278
ISSN
2015 Impact Factor: 1.684
2015 SCImago Journal Rankings: 0.881
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorMak, Aen_US
dc.contributor.authorCheung, MWen_US
dc.contributor.authorHo, RCMen_US
dc.contributor.authorCheak, AACen_US
dc.contributor.authorLau, CSen_US
dc.date.accessioned2012-09-05T05:29:35Z-
dc.date.available2012-09-05T05:29:35Z-
dc.date.issued2009en_US
dc.identifier.citationBmc Musculoskeletal Disorders, 2009, v. 10 n. 1en_US
dc.identifier.issn1471-2474en_US
dc.identifier.urihttp://hdl.handle.net/10722/163278-
dc.description.abstractBackground. Occurrence of atrial fibrillation (AF) amongst bisphosphonate users has been increasingly reported but results are conflicting. We performed a Bayesian meta-analysis to address the possible association between the occurrence of AF and bisphosphonate use and estimated the posterior probability of development of AF with bisphosphonate use. Methods. Randomized controlled trials (RCTs) evaluating the efficacy and safety of bisphosphonates for treating and preventing osteoporosis, and observational studies investigating the incidence of AF amongst bisphosphonate users, were searched in electronic databases. We pooled the effect size with Bayesian meta-analysis for odds ratio (OR) and calculated its posterior probability of development of AF in bisphosphonate users for RCTs and observational studies, reported with the 95% credible interval (CI). Results. Of 1751 potentially relevant citations initially retrieved, 4 RCTs and 2 reports of RCTs, and 3 observational studies were included for this meta-analysis. On pooling the RCTs, there was a non-significantly higher risk of overall (OR 1.184, 95% CI 0.837-1.656) and serious AF (OR 1.590, 95% CI 0.613-3.751) in bisphosphonate-treated patients. Combining data of observational studies also revealed a non-significantly higher risk of AF in bisphosphonate users (OR 1.251, 95% CI 0.980-1.732). Using Bayesian meta-analysis based on the effect size of observational studies as the prior, the posterior probability of OR1.2 in the development of AF amongst bisphosphonate users in the RCTs was 0.484. Egger's regression demonstrated no notable publication bias in all the analyses. Conclusion. The current meta-analysis revealed no evidence of a higher risk of AF associated with bisphosphonate use. Nevertheless, based on Bayesian meta-analysis with the effect size of the observational studies as the prior, the posterior probabilities of development of AF was found to be 0.484 if the risk of AF was estimated to be more than 20%. The results of the current meta-analysis thus offer clinicians the practical probability of development of AF in patients who take bisphosphonates for the treatment of bone loss and corticosteroid induced osteoporosis. © 2009 Mak et al.en_US
dc.languageengen_US
dc.publisherBioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcmusculoskeletdisord/en_US
dc.relation.ispartofBMC Musculoskeletal Disordersen_US
dc.subject.meshAtrial Fibrillation - Chemically Induced - Epidemiologyen_US
dc.subject.meshBayes Theoremen_US
dc.subject.meshDiphosphonates - Adverse Effectsen_US
dc.subject.meshHumansen_US
dc.subject.meshRandomized Controlled Trials As Topic - Methodsen_US
dc.subject.meshRisk Factorsen_US
dc.titleBisphosphonates and atrial fibrillation: Bayesian meta-analyses of randomized controlled trials and observational studiesen_US
dc.typeArticleen_US
dc.identifier.emailLau, CS:cslau@hku.hken_US
dc.identifier.authorityLau, CS=rp01348en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1186/1471-2474-10-113en_US
dc.identifier.pmid19772579en_US
dc.identifier.scopuseid_2-s2.0-70350434353en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-70350434353&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume10en_US
dc.identifier.issue1en_US
dc.identifier.isiWOS:000270555800001-
dc.publisher.placeUnited Kingdomen_US
dc.identifier.scopusauthoridMak, A=9248521200en_US
dc.identifier.scopusauthoridCheung, MW=35106852500en_US
dc.identifier.scopusauthoridHo, RCM=23004658600en_US
dc.identifier.scopusauthoridCheak, AAC=34871425800en_US
dc.identifier.scopusauthoridLau, CS=14035682100en_US
dc.identifier.citeulike5820361-

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