Osteoporosis Canada statement on esophageal cancer and bisphosphonate use

We are aware of a recent publication that reports on the association between oral bisphosphonate
use and esophageal cancer1.
We recognize that you might find these reports concerning. Osteoporosis Canada takes your
concerns seriously and we will continue to be vigilant in order to inform you about the latest
research. The publication has been reviewed by experts from the Scientific Advisory Committee
at Osteoporosis Canada and their response is below
It is a fact - all medications have risks associated with them. Osteoporosis medications are no
exception. Every time a physician recommends and prescribes a medication, it includes
carefully weighing the risks and benefits of taking a medication.
The study referenced above is a letter to the editor of the New England Journal of Medicine from
a member of the Food and Drug Administration (FDA) in the United States. The letter reports
that from October 1995 to mid May 2008 the FDA received reports of 23 patients who were
diagnosed with esophageal cancer while taking the oral bisphosphonate medication, alendronate.
There have been no reports of esophageal cancer associated with other oral bisphosphonates such
as risedronate or etidronate in the United States. However, in Europe and Japan, there have been
up to 10 cases of cancer of the esophagus with the other bisphosphonate medications. The author
concludes that further studies are required to establish whether a clear association exists.
The major limitation of this report, (also highlighted by the author) is the fact that this was not a
prospective randomized clinical trial - therefore it is not possible to state that bisphosphonates
cause esophageal cancer. Indeed, it is possible that the patients who developed cancer had
conditions that put them at risk for this type of cancer unrelated to the use of bisphosphonate
That said inflammation of the esophagus (esophagitis) can occur with the use of
bisphosphonates, usually when these medications are not taken according to directions. As a
result, it is important to ensure you are taking your medication properly. You may wish to
review this information with your health care professional to ensure that you are taking your
medication properly.
It is important to remember that esophageal cancer is a rare condition. Fractures (broken
bones) due to osteoporosis, on the other hand, are extremely common. Osteoporotic
fractures are linked to additional fractures, altered quality of life, worsening of other health
conditions and in some cases – death. Bisphosphonate medications provide protection from
osteoporotic fractures. It is important to remember that your physician carefully weighs the
risks and benefits of taking a medication for your unique situation every time he or she
recommends and prescribes a medication
. Your healthcare team is available to review any
concerns or questions you may have about this issue.
1. Wysowski DK, Reports of Esophageal Cancer with Oral Bisphosphonate Use. N Engl J Med



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