Osteoporosis drugs vary in their association with CVD risk

  • Bone

  • International Clinical Digest
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Takeaway

  • In this meta-analysis of 17 randomised controlled trials, denosumab showed no association with cardiovascular disease (CVD) risk in patients with primary osteoporosis, but romosozumab was tied to major adverse cardiovascular event (MACE) risk.

Why this matters

  • Other meta-analyses have addressed safety and efficacy of these drugs but not with a focus on CVD risk, these authors say.

Key results

  • Denosumab was not associated with increased risk for MACE or specific CVD outcomes.
  • Romosozumab was associated with increased risk for a 4-point MACE outcome: risk ratio, 1.39 (95% CI, 1.01-1.90; P=.04), which was adjusted down only slightly in sensitivity analyses.
  • Heterogeneity for this analysis was 0%.

Study design

  • Meta-analysis of 17 randomised trials (12 double blind; 5 open label) with 11 trials of denosumab (n=13,615) and 6 of romosozumab (n=12,219).
  • 4-point MACE: composite of cardiovascular death/death, myocardial infarction, stroke, heart failure.
  • Funding: National Key R and D Program of China.

Limitations

  • The trials varied in the cardiovascular endpoints examined.
  • Bias risk is unclear because of scant descriptions of adverse events.