Author + information
- Marc R. Dweck, MD, PhD⁎ ( and )
- David E. Newby, MD, PhD
- ↵⁎Centre for Cardiovascular Sciences, University of Edinburgh, Chancellor's Building, Little France Crescent, Edinburgh, Scotland EH16 4SB, United Kingdom
We read the paper “Do Bisphosphonates Slow the Progression of Aortic Stenosis” by Aksoy et al. (1) with great interest. Given the central role that calcification plays in the progression of aortic stenosis, the question as to whether bisphosphonates might favorably modify this disease process is an important one.
In their large retrospective study, the researchers found that there was no difference in aortic stenosis progression between women who were taking and not taking bisphosphonate therapy after a median follow-up of 1.6 years. This lack of effect persisted even after sophisticated propensity matching; however, we believe that this analysis did not correct for one potentially important confounder.
The link between osteoporosis and increased vascular calcification, the so-called calcification paradox, is well established, and the researchers themselves previously extended this principle to aortic valve calcification (2–4). We therefore believe that the presence of osteoporosis in those prescribed bisphosphonate therapy may have had a significant incremental effect on aortic stenosis progression. As such, the lack of difference between the groups could be interpreted as a sign that bisphosphonates were in fact successful in normalizing disease progression in these patients.
In our opinion, it is unlikely that observational studies will be able to disentangle the effects of bisphosphonates and osteoporosis on aortic stenosis. The true impact of these drugs will only become clear within the setting of a randomized controlled trial.
- American College of Cardiology Foundation