Bisphosphonates May Reduce Heart Attack Risk in RA Patients

Preliminary study finds a benefit, but follow-up studies are needed.

Arthritis Today—May 10, 2013

A new study published in the May issue of Journal of Bone and Mineral Research (JBMR) found that use of bisphosphonates – bone-building drugs – appear to significantly lower the risk of heart attacks in rheumatoid arthritis (RA) patients.

People with RA (as well as other forms of inflammatory arthritis, such as psoriatic arthritis and ankylosing spondylitis) have an increased risk of cardiovascular events, including heart attack, as a result of chronic inflammation. Many also take bisphosphonates to counteract bone loss caused by the disease and by corticosteroids – powerful anti-inflammatories sometimes used to control symptoms.

This combination of high incidence for both cardiac events and bisphosphonate use is one reason the researchers say they decided to use a group of RA patients to test their hypothesis that bisphosphonates lower the risk of death not just by reducing fractures, but also by protecting the heart.

This emerging benefit – if confirmed – may help neutralize fears over the use of bisphosphonates due to certain relatively rare – but highly publicized – side effects: atypical femur fracture and osteonecrosis of the jaw. To reduce the risk – and because there is still no consensus on how long bisphosphonates should be taken – doctors may take their patients off the medication after two to five years, depending on the patient’s risk factors. Linda A. Russell, MD, a rheumatologist and director of perioperative services at New York’s Hospital for Special Surgery, says this added benefit could be a reason to continue treatment longer.

“It’s just a wonderful side benefit if you can treat their osteoporosis and reduce their heart attack risk,” Dr. Russell says.

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