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Posted on 09-03-2010

A study published lately in the BMJ shows doubled risk of Throat and Esophagus Cancer with medications such as Fosalan, Actonel etc. taken over an average of 5 years period. This 8 year study contradicts the results of a 4 year  study published in the JAMA that showed no correlation between Bisphosphonates and cancer.

Oral bisphosphonates and risk of cancer of oesophagus, stomach, and colorectum: case-control analysis within a UK primary care cohort

  1. Jane Green, clinical epidemiologist1,
  2. Gabriela Czanner, statistician1,
  3. Gillian Reeves, statistical epidemiologist1,
  4. Joanna Watson, epidemiologist1,
  5. Lesley Wise, manager, Pharmacoepidemiology Research and Intelligence Unit2,
  6. Valerie Beral, professor of cancer epidemiology1

+Author Affiliations

  1. 1Cancer Epidemiology Unit, University of Oxford, Oxford OX3 7LF
  2. 2Medicines and Healthcare products Regulatory Agency, Pharmacoepidemiology Research Unit, London SW8 5NQ
  1. Correspondence to: J Green [email protected]
  • Accepted 23 June 2010


Objective To examine the hypothesis that risk of oesophageal, but not of gastric or colorectal, cancer is increased in users of oral bisphosphonates.

Design Nested case-control analysis within a primary care cohort of about 6 million people in the UK, with prospectively recorded information on prescribing of bisphosphonates.

Setting UK General Practice Research Database cohort.

Participants Men and women aged 40 years or over-2954 with oesophageal cancer, 2018 with gastric cancer, and 10 641 with colorectal cancer, diagnosed in 1995-2005; five controls per case matched for age, sex, general practice, and observation time.

Main outcome measures Relative risks for incident invasive cancers of the oesophagus, stomach, and colorectum, adjusted for smoking, alcohol, and body mass index.

Results The incidence of oesophageal cancer was increased in people with one or more previous prescriptions for oral bisphosphonates compared with those with no such prescriptions (relative risk 1.30, 95% confidence interval 1.02 to1.66; P=0.02). Risk of oesophageal cancer was significantly higher for 10 or more prescriptions (1.93, 1.37 to 2.70) than for one to nine prescriptions (0.93, 0.66 to 1.31) (P for heterogeneity=0.002), and for use for over 3 years (on average, about 5 years: relative risk v no prescription, 2.24, 1.47 to 3.43). Risk of oesophageal cancer did not differ significantly by bisphosphonate type, and risk in those with 10 or more bisphosphonate prescriptions did not vary by age, sex, smoking, alcohol intake, or body mass index; by diagnosis of osteoporosis, fracture, or upper gastrointestinal disease; or by prescription of acid suppressants, non-steroidal anti-inflammatory drugs, or corticosteroids. Cancers of the stomach and colorectum were not associated with prescription of bisphosphonate: relative risks for one or more versus no prescriptions were 0.87 (0.64 to 1.19) and 0.87 (0.77 to 1.00). The specificity of the association for oesophageal cancer argues against methodological problems in the selection of cases and controls or in the analysis.

Conclusions The risk of oesophageal cancer increased with 10 or more prescriptions for oral bisphosphonates and with prescriptions over about a five year period. In Europe and North America, the incidence of oesophageal cancer at age 60-79 is typically 1 per 1000 population over five years, and this is estimated to increase to about 2 per 1000 with five years' use of oral bisphosphonates.

Read the full article:  http://www.bmj.com/content/341/bmj.c4444.full 

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