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Osteoporosis and Esophageal Cancer

Can taking daily osteoporosis drugs increase your risk of cancer? Researchers turn to big data for answers.

Common treatments for osteoporosis (bisphosphonates like Boniva or Fosamax), prescribed to strengthen bones and reduce the risk of fracture, can irritate the esophagus in some patients. Do these drugs increase your risk for cancer?

Drugs used to treat osteoporosis can irritate the esophagus in some patients.

Drugs used to treat osteoporosis can irritate the esophagus in some patients. Do these drugs increase your risk for esophageal cancer?

If you take daily medication for osteoporosis, are you increasing your risk for esophageal cancer? After several published research studies delivered conflicting conclusions, Nancy E. Morden, MD, MPH, assistant professor of Community and Family Medicine and at the Dartmouth Institute, directed a large population data base study to answer this question.

"After evaluating 1.64 million people taking bisphosphonates between 2006-2010, we found no evidence of increased risk of esophageal cancer," she said. "This finding, in the largest observational study to date, is reassuring for patients taking bisphosphonate medications to reduce their risk of fracture from osteoporosis."

Can osteoporosis medications increase your risk for esophageal cancer?

Some of the earlier research suggested that bisphosphonates, the drugs many women take for osteoporosis, increased the risk of esophageal cancer. Other studies found no association, and some even reported that these drugs protected a woman from esophageal cancer risk.

Nancy Morden, MD, directed a study that found no link between osteoporosis drugs and esophageal cancer.

Nancy Morden, MD, directed a study that found no link between osteoporosis drugs and esophageal cancer.

The confusion left patients and physicians in a stressful position: with no conclusive study to help, how could they weigh the proven benefits of reduced fracture risk against a possible increased cancer risk? Women taking these medications usually do so for extended periods of time, which made the problem even more disturbing. Was there a risk? Was the risk worth taking?

Big data research translates esophageal cancer risk findings into information patients can use

Big data studies like Morden's are especially important because the drugs the FDA approves are usually tested in isolation for short periods of time (often 12 weeks). But this is not how they are used in real life, where people often take several prescription drugs for long periods of time. The FDA safety studies done for marketing approval may not reveal adverse effects that can emerge later.

"This is the purpose of our research," Morden said. "We examine the health impact of prescription drugs as they are used by real populations over long periods of time to understand their safety. We can also use this dataset and these methods to detect important unanticipated beneficial effects of medications that might suggest broader use is warranted."

Methods developed to look at cancer risk and drug safety in real life settings

Morden notes that while her team found no evidence of increased risk of esophageal cancer, it can take years for associations between exposure and cancer to surface—tobacco exposure and lung cancer is a good example of this. The methods developed for this study will help researchers bring other questions to large population databases, allowing them to explore possible associations between prescription drugs and other cancers, fractures, and cardiac events.

Learn more about our research and clinical trials:

October 18, 2013