Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Aug 11;304(6):657-63.
doi: 10.1001/jama.2010.1098.

Exposure to oral bisphosphonates and risk of esophageal cancer

Chris R Cardwell  1 , Christian C Abnet, Marie M Cantwell, Liam J Murray
Affiliations

Exposure to oral bisphosphonates and risk of esophageal cancer

Chris R Cardwell et al. JAMA. .

Abstract

Context: Use of oral bisphosphonates has increased dramatically in the United States and elsewhere. Esophagitis is a known adverse effect of bisphosphonate use, and recent reports suggest a link between bisphosphonate use and esophageal cancer, but this has not been robustly investigated.

Objective: To investigate the association between bisphosphonate use and esophageal cancer.

Design, setting, and participants: Data were extracted from the UK General Practice Research Database to compare the incidence of esophageal and gastric cancer in a cohort of patients treated with oral bisphosphonates between January 1996 and December 2006 with incidence in a control cohort. Cancers were identified from relevant Read/Oxford Medical Information System codes in the patient's clinical files. Cox proportional hazards modeling was used to calculate hazard ratios and 95% confidence intervals for risk of esophageal and gastric cancer in bisphosphonate users compared with nonusers, with adjustment for potential confounders.

Main outcome measure: Hazard ratio for the risk of esophageal and gastric cancer in the bisphosphonate users compared with the bisphosphonate nonusers.

Results: Mean follow-up time was 4.5 and 4.4 years in the bisphosphonate and control cohorts, respectively. Excluding patients with less than 6 months' follow-up, there were 41 826 members in each cohort (81% women; mean age, 70.0 (SD, 11.4) years). One hundred sixteen esophageal or gastric cancers (79 esophageal) occurred in the bisphosphonate cohort and 115 (72 esophageal) in the control cohort. The incidence of esophageal and gastric cancer combined was 0.7 per 1000 person-years of risk in both the bisphosphonate and control cohorts; the incidence of esophageal cancer alone in the bisphosphonate and control cohorts was 0.48 and 0.44 per 1000 person-years of risk, respectively. There was no difference in risk of esophageal and gastric cancer combined between the cohorts for any bisphosphonate use (adjusted hazard ratio, 0.96 [95% confidence interval, 0.74-1.25]) or risk of esophageal cancer only (adjusted hazard ratio, 1.07 [95% confidence interval, 0.77-1.49]). There also was no difference in risk of esophageal or gastric cancer by duration of bisphosphonate intake.

Conclusion: Among patients in the UK General Practice Research Database, the use of oral bisphosphonates was not significantly associated with incident esophageal or gastric cancer.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest and Financial Disclosures: None.

Figures

Figure 1
Figure 1
Time to esophageal and gastric cancer or esophageal cancer only in the bisphosphonate (—) and contol (--) cohort.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Usher C, Teeling M, Bennett K, Feely J. Effect of clinical trial publicity on HRT prescribing in Ireland. Eur J Clin Pharmacol. 2006;62(4):307–310. - PubMed
    1. Udell JA, Fischer MA, Brookhart MA, Solomon DH, Choudhry NK. Effect of the Women's Health Initiative on osteoporosis therapy and expenditure in Medicaid. J Bone Miner Res. 2006;21(5):765–771. - PubMed
    1. Watson J, Wise L, Green J. Prescribing of hormone therapy for menopause, tibolone, and bisphosphonates in women in the UK between 1991 and 2005. Eur J Clin Pharmacol. 2007;63(9):843–849. - PubMed
    1. Ryan JM, Kelsey P, Ryan BM, Mueller PR. Alendronate-induced esophagitis: case report of a recently recognized form of severe esophagitis with esophageal stricture--radiographic features. Radiology. 1998;206(2):389–391. - PubMed
    1. de Groen PC, Lubbe DF, Hirsch LJ, et al. Esophagitis associated with the use of alendronate. N Engl J Med. 1996;335(14):1016–1021. - PubMed

Publication types

MeSH terms