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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Gastroenterology 1/2014

Oral bisphosphonates do not increase the risk of severe upper gastrointestinal complications: a nested case–control study

BMC Gastroenterology > Ausgabe 1/2014
Arianna Ghirardi, Lorenza Scotti, Gianluca Della Vedova, Luca Cavalieri D’Oro, Francesco Lapi, Francesco Cipriani, Achille P Caputi, Alberto Vaccheri, Dario Gregori, Rosaria Gesuita, Annarita Vestri, Tommaso Staniscia, Giampiero Mazzaglia, Giovanni Corrao
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-230X-14-5) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

AG and LS performed the statistical analyses, GDV was responsible for producing software assuring privacy, AG and GC wrote the paper, GC was responsible for designing the current study, GM was the main investigator of the AIFA-BEST project, LCDO, FL, FC, AC, AV, DG, RG, ARV and TS were the other investigators of the AIFA-BEST; they participated to the project’s design and supplied data. All authors read and approved the final manuscript.



Data on the effect of oral bisphosphonates (BPs) on risk of upper gastrointestinal complications (UGIC) are conflicting. We conducted a large population-based study from a network of Italian healthcare utilization databases aimed to assess the UGIC risk associated with use of BPs in the setting of secondary prevention of osteoporotic fractures.


A nested case–control study was carried out within a cohort of 68,970 patients aged 45 years or older, who have been hospitalized for osteoporotic fracture from 2003 until 2005. Cases were the 804 patients who experienced hospitalization for UGIC until 2007. Up to 20 controls were randomly selected for each case. Conditional logistic regression model was used to estimate odds ratio (OR) associated with current and past use of BPs (i.e. for drug dispensation within 30 days and over 31 days prior the outcome onset, respectively) after adjusting for several covariates.


Compared with patients who did not use BPs, current and past users had OR (and 95% confidence interval) of 0.86 (0.60 to 1.22) and 1.07 (0.80 to 1.44) respectively. There was no difference in the ORs estimated according with BPs type (alendronate or risedronate) and regimen (daily or weekly), nor with co-therapies and comorbidities.


Further evidence that BPs dispensed for secondary prevention of osteoporotic fractures are not associated with increased risk of severe gastrointestinal complications is supplied from this study. Further research is required to clarify the role BPs and other drugs of co-medication in inducing UGIC.
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