Table 52Risks of Adverse Events for bisphosphonates versus placebo

Event GroupAlendronateIbandronateRisedronateZoledronic acid
# of TrialsOR (95% CI)# of TrialsOR (95% CI)# of TrialsOR (95% CI)# of TrialsOR (95% CI)
Cardiovascular
Acute Coronary Syndrome33.59 (0.35, 180)21.06 (0.41, 2.96)30.4 (0.06, 2.39)20.82 (0.55, 1.21)
Cerebrovascular Death2Inf+(0.13, Inf+)*21.06 (0.41, 2.96)2Inf+ (0.13, Inf+)*20.61 (0.26, 1.37)
Atrial Fibrillation11.26 (0.96, 1.66)0NR1Inf+ (0.02, Inf+)*21.45 (1.14, 1.86)
Cerebrovascular Accidents (serious)0NR20.32 (0, 27.3)0NR21.13 (0.9, 1.42)
Pulmonary Embolism0NR0NR20.74, (0.08, 8.89)0NR
Thromboembolic Events1Inf+ (0.03, Inf+)*0NR0NR0NR
Cancer
Breast Cancer1Inf+ (0.09, Inf+)*1Inf+ (0.01, Inf+)*0NR0NR
Colon Cancer0NR0NR0NR0NR
Esophageal CancerNo trials examined individual bisphosphonates. Pooled results for two observational studies: OR 1.23 (1.01, 1.49); see text for descriptions of findings of additional observational studies.
Lung Cancer0NR0NR10.49 (0.01, 38.4)0NR
Osteosarcoma0NR0NR0NR0NR
GI (mild)
GI (mild) All501.08 (1.01, 1.15)101.03 (0.92, 1.14)211.03 (0.95, 1.13)31.44 (0.84, 2.5)
GI (Serious)
Esophageal (serious)51.39 (0.75, 2.65)11.5 (0.12, 78.7)40.74 (0.38, 1.46)0NR
Upper GI Perforations, Ulcers, or Bleeds (not esophageal)100.88 (0.66, 1.18)20.33 (0.14, 0.74)70.64 (0.27, 1.53)0NR
Musculoskeletal
Arthritis and Arthralgias30.27 (0.09, 0.70)10.53 (0.11, 2.43)50.77 (0.45, 1.32)52.31 (1.90, 2.82)
Myalgias, Cramps, Limb Pain41.14 (0.18, 8.18)22.25 (1.57, 3.29)0NR64.15 (3.41, 5.08)
Atypical FracturesSee text for description of comprehensive review and subsequent observational studies of all bisphosphonates.
Osteonecrosis of the JawSee text for description of reviews and observational studies.

INF = infinite; OR = odds ratio; NR = not reported

*

For comparisons with zero events in one arm the odds ratio and the upper bound of the confidence interval is infinity.

For comparisons with zero events in one arm the odds ratio and the upper bound of the confidence interval is infinity.

From: Results

Cover of Treatment To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis: Update of a 2007 Report
Treatment To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis: Update of a 2007 Report [Internet].
Comparative Effectiveness Reviews, No. 53.
Crandall CJ, Newberry SJ, Diamant A, et al.

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