Bisphosphonates and atrial fibrillation: revisiting the controversy. Issue 1 (24th March 2020)

• Record Type: Journal Article
• Authors: Fazmin, Ibrahim T.; Huang, Christopher L.‐H.; Jeevaratnam, Kamalan
• Is Part Of: Annals of the New York Academy of Sciences. Volume 1474:Issue 1(2020)
• Page Start: 15
• Page End: 26
• Publication Date: 2020-03-24
• Subjects: bisphosphonates -- atrial fibrillation -- arrhythmia -- inflammation -- electrophysiology -- cardiac physiology; Medical sciences -- Periodicals; Medicine -- Periodicals; Science -- Periodicals; 610
• DOI: 10.1111/nyas.14332
• Languages: English
• ISSNs: 0077-8923

Abstract

Abstract: Bisphosphonates (BPs) are widely prescribed drugs used to treat osteoporosis, commonly arising in postmenopausal women and in chronic glucocorticoid use. Their mechanism of action is through inhibiting osteoclast‐induced bone remodeling, and they also possess calcium sequestering properties. Common side effects involve the gastrointestinal system and rare but serious side effects, including osteonecrosis of the jaw. However, a link between BPs and atrial fibrillation (AF) has been proposed, with early clinical trials, such as the Fracture Intervention Trial and the HORIZON Pivotal Fracture Trial, reporting that BPs are associated with increased risk of AF. Nevertheless, subsequent studies have reported contrasting results, ranging from no effect of BPs to antiarrhythmic effects of BPs. Preclinical and electrophysiological studies on any proarrhythmic effect of BPs are limited in scope and number, but suggest possible mechanisms that include antiangionesis‐related myocardial remodeling, calcium handling abnormalities, and inflammatory changes. Contrastingly, some studies indicate that BPs are antiarrhythmic by inhibiting fibrotic myocardial remodeling. In order to continue established clinical prescribing of BPs within absolute margins of safety, it will be necessary to systematically rule in/rule out these mechanisms. Thus, we discuss these studies and examine in detail the potential mechanistic links, with the aim of suggesting further avenues for research. Abstract : Bisphosphonates (BPs) are widely prescribed drugs used to treat osteoporosis. Common side effects involve the gastrointestinal system and rare but serious side effects including osteonecrosis of the jaw. However, a link between BPs and atrial fibrillation (AF) has been proposed in several studies. We discuss these studies and examine in detail potential mechanistic links between BPs and AF, with the aim of suggesting further avenues for research.