The impact of preadmission oral bisphosphonate use on 30-day mortality following stroke: A population-based cohort study of 100,043 patients

Diana Hedevang Christensen, E. Puhó, Morten Schmidt, Christian Fynbo Christiansen, Lars Pedersen, Bente Lomholt Langdahl, Reimar Wernich Thomsen

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Abstract

Purpose: Bisphosphonate use has been associated with increased risk of fatal stroke. We examined the association between preadmission use of oral bisphosphonates and 30-day mortality following hospitalization for stroke. Patients and methods: We conducted a nationwide population-based cohort study using medical databases and identified all patients in Denmark with a first-time hospitalization for stroke between 1 July 2004 and 31 December 2012 (N=100,043). Cox regression was used to compute adjusted hazard ratios as a measure of 30-day mortality rate ratios (MRRs) associated with bisphosphonate current use (prescription filled within 90 days prior to the stroke) or recent use (prescription filled in the 90–180 days prior to the stroke). Current use was further classified as new or long-term use. Results: We found 51,982 patients with acute ischemic stroke (AIS), 11,779 with intracerebral hemorrhage (ICH), 4,528 with subarachnoid hemorrhage (SAH), and 31,754 with unspecified stroke. Absolute 30-day mortality risks were increased among current vs nonusers of bisphosphonates for AIS (11.9% vs 8.5%), ICH (43.2% vs 34.5%), SAH (40.3% vs 23.2%), and unspecified strokes (18.8% vs 14.0%). However, in adjusted analyses, current bisphosphonate use did not increase 30-day mortality from AIS (MRR, 0.87; 95% confidence interval [CI]: 0.75, 1.01); ICH (MRR, 1.05; 95% CI: 0.90, 1.23); SAH (MRR, 1.15; 95% CI: 0.83, 1.61); or unspecified stroke (MRR, 0.94; 95% CI: 0.81, 1.09). Likewise, no association with mortality was found for recent use. Adjusted analyses by type of bisphosphonate showed increased mortality following stroke among new users of etidronate (MRR, 1.40; 95% CI: 1.01, 1.93) and reduced mortality after AIS among current users of alendronate (MRR, 0.87; 95% CI: 0.74, 1.02). Conclusion: We found no overall evidence that preadmission bisphosphonate use increases 30-day mortality following stroke.

Original languageEnglish
Pages (from-to)381-389
Number of pages9
JournalClinical Epidemiology
Volume7
DOIs
Publication statusPublished - Aug 24 2015

Fingerprint

Diphosphonates
Cohort Studies
Stroke
Mortality
Population
Confidence Intervals
Cerebral Hemorrhage
Subarachnoid Hemorrhage
Prescriptions
Hospitalization
Etidronic Acid
Alendronate
Denmark

Keywords

  • Cardiovascular disease
  • Mortality
  • Oral bisphosphonates
  • Osteoporosis treatment
  • Prognosis
  • Stroke

ASJC Scopus subject areas

  • Epidemiology

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The impact of preadmission oral bisphosphonate use on 30-day mortality following stroke : A population-based cohort study of 100,043 patients. / Christensen, Diana Hedevang; Puhó, E.; Schmidt, Morten; Christiansen, Christian Fynbo; Pedersen, Lars; Langdahl, Bente Lomholt; Thomsen, Reimar Wernich.

In: Clinical Epidemiology, Vol. 7, 24.08.2015, p. 381-389.

Research output: Contribution to journalArticle

Christensen, Diana Hedevang ; Puhó, E. ; Schmidt, Morten ; Christiansen, Christian Fynbo ; Pedersen, Lars ; Langdahl, Bente Lomholt ; Thomsen, Reimar Wernich. / The impact of preadmission oral bisphosphonate use on 30-day mortality following stroke : A population-based cohort study of 100,043 patients. In: Clinical Epidemiology. 2015 ; Vol. 7. pp. 381-389.
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abstract = "Purpose: Bisphosphonate use has been associated with increased risk of fatal stroke. We examined the association between preadmission use of oral bisphosphonates and 30-day mortality following hospitalization for stroke. Patients and methods: We conducted a nationwide population-based cohort study using medical databases and identified all patients in Denmark with a first-time hospitalization for stroke between 1 July 2004 and 31 December 2012 (N=100,043). Cox regression was used to compute adjusted hazard ratios as a measure of 30-day mortality rate ratios (MRRs) associated with bisphosphonate current use (prescription filled within 90 days prior to the stroke) or recent use (prescription filled in the 90–180 days prior to the stroke). Current use was further classified as new or long-term use. Results: We found 51,982 patients with acute ischemic stroke (AIS), 11,779 with intracerebral hemorrhage (ICH), 4,528 with subarachnoid hemorrhage (SAH), and 31,754 with unspecified stroke. Absolute 30-day mortality risks were increased among current vs nonusers of bisphosphonates for AIS (11.9{\%} vs 8.5{\%}), ICH (43.2{\%} vs 34.5{\%}), SAH (40.3{\%} vs 23.2{\%}), and unspecified strokes (18.8{\%} vs 14.0{\%}). However, in adjusted analyses, current bisphosphonate use did not increase 30-day mortality from AIS (MRR, 0.87; 95{\%} confidence interval [CI]: 0.75, 1.01); ICH (MRR, 1.05; 95{\%} CI: 0.90, 1.23); SAH (MRR, 1.15; 95{\%} CI: 0.83, 1.61); or unspecified stroke (MRR, 0.94; 95{\%} CI: 0.81, 1.09). Likewise, no association with mortality was found for recent use. Adjusted analyses by type of bisphosphonate showed increased mortality following stroke among new users of etidronate (MRR, 1.40; 95{\%} CI: 1.01, 1.93) and reduced mortality after AIS among current users of alendronate (MRR, 0.87; 95{\%} CI: 0.74, 1.02). Conclusion: We found no overall evidence that preadmission bisphosphonate use increases 30-day mortality following stroke.",
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T2 - A population-based cohort study of 100,043 patients

AU - Christensen, Diana Hedevang

AU - Puhó, E.

AU - Schmidt, Morten

AU - Christiansen, Christian Fynbo

AU - Pedersen, Lars

AU - Langdahl, Bente Lomholt

AU - Thomsen, Reimar Wernich

PY - 2015/8/24

Y1 - 2015/8/24

N2 - Purpose: Bisphosphonate use has been associated with increased risk of fatal stroke. We examined the association between preadmission use of oral bisphosphonates and 30-day mortality following hospitalization for stroke. Patients and methods: We conducted a nationwide population-based cohort study using medical databases and identified all patients in Denmark with a first-time hospitalization for stroke between 1 July 2004 and 31 December 2012 (N=100,043). Cox regression was used to compute adjusted hazard ratios as a measure of 30-day mortality rate ratios (MRRs) associated with bisphosphonate current use (prescription filled within 90 days prior to the stroke) or recent use (prescription filled in the 90–180 days prior to the stroke). Current use was further classified as new or long-term use. Results: We found 51,982 patients with acute ischemic stroke (AIS), 11,779 with intracerebral hemorrhage (ICH), 4,528 with subarachnoid hemorrhage (SAH), and 31,754 with unspecified stroke. Absolute 30-day mortality risks were increased among current vs nonusers of bisphosphonates for AIS (11.9% vs 8.5%), ICH (43.2% vs 34.5%), SAH (40.3% vs 23.2%), and unspecified strokes (18.8% vs 14.0%). However, in adjusted analyses, current bisphosphonate use did not increase 30-day mortality from AIS (MRR, 0.87; 95% confidence interval [CI]: 0.75, 1.01); ICH (MRR, 1.05; 95% CI: 0.90, 1.23); SAH (MRR, 1.15; 95% CI: 0.83, 1.61); or unspecified stroke (MRR, 0.94; 95% CI: 0.81, 1.09). Likewise, no association with mortality was found for recent use. Adjusted analyses by type of bisphosphonate showed increased mortality following stroke among new users of etidronate (MRR, 1.40; 95% CI: 1.01, 1.93) and reduced mortality after AIS among current users of alendronate (MRR, 0.87; 95% CI: 0.74, 1.02). Conclusion: We found no overall evidence that preadmission bisphosphonate use increases 30-day mortality following stroke.

AB - Purpose: Bisphosphonate use has been associated with increased risk of fatal stroke. We examined the association between preadmission use of oral bisphosphonates and 30-day mortality following hospitalization for stroke. Patients and methods: We conducted a nationwide population-based cohort study using medical databases and identified all patients in Denmark with a first-time hospitalization for stroke between 1 July 2004 and 31 December 2012 (N=100,043). Cox regression was used to compute adjusted hazard ratios as a measure of 30-day mortality rate ratios (MRRs) associated with bisphosphonate current use (prescription filled within 90 days prior to the stroke) or recent use (prescription filled in the 90–180 days prior to the stroke). Current use was further classified as new or long-term use. Results: We found 51,982 patients with acute ischemic stroke (AIS), 11,779 with intracerebral hemorrhage (ICH), 4,528 with subarachnoid hemorrhage (SAH), and 31,754 with unspecified stroke. Absolute 30-day mortality risks were increased among current vs nonusers of bisphosphonates for AIS (11.9% vs 8.5%), ICH (43.2% vs 34.5%), SAH (40.3% vs 23.2%), and unspecified strokes (18.8% vs 14.0%). However, in adjusted analyses, current bisphosphonate use did not increase 30-day mortality from AIS (MRR, 0.87; 95% confidence interval [CI]: 0.75, 1.01); ICH (MRR, 1.05; 95% CI: 0.90, 1.23); SAH (MRR, 1.15; 95% CI: 0.83, 1.61); or unspecified stroke (MRR, 0.94; 95% CI: 0.81, 1.09). Likewise, no association with mortality was found for recent use. Adjusted analyses by type of bisphosphonate showed increased mortality following stroke among new users of etidronate (MRR, 1.40; 95% CI: 1.01, 1.93) and reduced mortality after AIS among current users of alendronate (MRR, 0.87; 95% CI: 0.74, 1.02). Conclusion: We found no overall evidence that preadmission bisphosphonate use increases 30-day mortality following stroke.

KW - Cardiovascular disease

KW - Mortality

KW - Oral bisphosphonates

KW - Osteoporosis treatment

KW - Prognosis

KW - Stroke

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