Background
Osteoporosis is one of the most common diseases of the skeletal system, particularly occurring in older adults. Bisphosphonates are frequently used to treat osteoporosis and prevent bone fractures. Studies evaluating the association between treatment with bisphosphonate and the risk of atrial fibrillation have reported conflicting results. This meta-analysis of observational studies was performed to assess this association.
Methods
Databases were searched to find relevant observational studies, and the identified articles were selected according to the selection criteria. Sensitivity and subgroup analysis based on various confounding factors were performed. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of atrial fibrillation were estimated using a random-effects model.
Results
We selected 12 studies, including four case-control and eight cohort studies, for the meta-analysis. Assessment of the estimated effect size yielded an OR of 1.171 (95% CI, 1.011–1.356; P=0.035), with substantial heterogeneity (I2 =84.74%, P<0.001). When the studies were excluded one-after-another, the pooled OR remained unchanged in only six studies. In addition, subgroup analyses found that treatment with bisphosphonates was positively associated with the risk of atrial fibrillation in studies performed in Western countries (OR, 1.263; 95% CI, 1.092–1.462) and lower-quality studies (OR, 1.214; 95% CI, 1.035–1.423). No publication bias was observed.
Conclusion
This meta-analysis showed that treatment with bisphosphonates may be associated with an increased risk of atrial fibrillation. Therefore, bisphosphonates should be carefully prescribed to patients at a high risk of atrial fibrillation.

Citations

• Polyphyllin VI: A promising treatment for prostate cancer bone metastasis
  Yanbin Feng, Yaomin Mo, Yang Zhang, Yilin Teng, Deshuang Xi, Junhong Zhou, Gaofeng Zeng, Shaohui Zong
  International Immunopharmacology.2025; 144: 113684.     CrossRef
• Prevalence and Clinical Implications of Osteosarcopenia in Patients With Acute Stroke
  Kyoung Tae Kim, Soyoung Lee, Jang Hyuk Cho, Yongmin Choi
  American Journal of Physical Medicine & Rehabilitation.2025; 104(2): 101.     CrossRef
• Beyond the Bone Health: A Narrative Review Unveiling the Role of Bisphosphonates in Reducing the Risk of Myocardial Infarction
  Pakeezah Tabasum, Muhammad Umar, Riya Mary Richard, Saba Khan, FNU Momna, Durr e Shahwar, Ayesha Hidayat, Abdulqadir J Nashwan, Waseem Sajjad, Waleed Inayat Mohamed
  Cureus.2025;[Epub]     CrossRef
• Zoledronic acid: challenges and pitfalls amid rehabilitation in primary osteoporosis and beyond
  Alexandru Florin Florescu, Oana-Claudia Sima, Mihai Costăchescu, Mihaela Stanciu, Ligia Florina Popa, Claudiu Nistor, Mădălina Gabriela Iliescu, Mihai-Lucian Ciobica, Mara Carsote
  Balneo and PRM Research Journal.2024; 15(Vol.15, no): 704.     CrossRef
• Additional effects of herbal medicine combined with bisphosphonates for primary osteoporosis: a systematic review and meta-analysis
  Young-Seo Yoo, Min-Gyeong Kim, Hee-Joo Park, Min-Young Chae, Yu-Jin Choi, Chae-Kun Oh, Chang-Gue Son, Eun-Jung Lee
  Frontiers in Pharmacology.2024;[Epub]     CrossRef
• Association of oral bisphosphonates with cardioembolic ischemic stroke: a nested case-control study
  Sara Rodríguez-Martín, Diana Barreira-Hernández, Ramón Mazzucchelli, Miguel Gil, Alberto García-Lledó, Laura Izquierdo-Esteban, Ana Pérez-Gómez, Antonio Rodríguez-Miguel, Francisco J. De Abajo
  Frontiers in Pharmacology.2023;[Epub]     CrossRef