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NSAIDs May Interfere With Efficacy of Bisphosphonates

No reduction in osteoporotic fracture risk seen among women receiving concomitant clodronate and NSAIDs

FRIDAY, April 22, 2022 (HealthDay News) — The efficacy of the bisphosphonate clodronate for reducing osteoporotic fracture risk appears to be negated in adults using nonsteroidal anti-inflammatory drugs (NSAIDs), according to a study published online April 20 in the Journal of Bone and Mineral Research.

Zhangan Zheng, from University of Sheffield in the United Kingdom, and colleagues evaluated the relationship between NSAIDs and fracture risk in a post hoc analysis of a randomized, placebo-controlled study of clodronate.

The researchers found that 20.8 percent of women reported use of NSAIDs at baseline and NSAID use was associated with a significant increase in osteoporotic fracture risk over three years (hazard ratio [HR], 1.27; 95 percent confidence interval [CI], 1.01 to 1.62; P = 0.039). In the placebo group, no statistically significant increase in risk was seen (HR 1.11; 95 percent CI, 0.81 to 1.52). Among women receiving clodronate, a decrease in osteoporotic fracture risk was seen in those not using NSAIDs (HR, 0.71; 95 percent CI, 0.58 to 0.89; P = 0.002), but not in those receiving NSAIDs (HR, 0.95; 95 percent CI, 0.65 to 1.41; P = 0.81).

“We need to exercise some caution in extrapolating these data to more widely used bisphosphonates in osteoporosis but given that concomitant usage of NSAIDs and bisphosphonates is relatively common, this could have major clinical consequences and result in a failure to reduce fracture risk as much as we had hoped,” a coauthor said in a statement.

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