This nested case–control study was based on a cohort encompassing over 110,000 women treated for osteoporosis, mostly with alendronate. A small proportion was receiving strontium ranelate. In our study, current use of strontium ranelate in patients with postmenopausal osteoporosis was not associated with increased risk for first definite

MI versus patients who had never received the treatment. Similar results were found for hospitalisation with MI and cardiovascular death, and for patients who had used the treatment in the past. Our results also suggest that current use of alendronate could have a cardioprotective effect. This is not the first such finding learn more for alendronate [15], but the underlying reasons Small molecule library remain unclear, and the use of a retrospective, observational, case–control study design, as well as the borderline significance of the

result precludes firm conclusions on this point until further research is performed. The mean duration of prior exposure to strontium ranelate was around 1 year for cases and controls. Although longer-term exposure is not available in CPRD, these data reflect the real-life pattern of strontium ranelate use from clinical practice in the UK. The robustness of the analysis is demonstrated by the consistency of our observations over the three outcomes considered. A number of sensitivity analyses have been performed using various definitions of exposure. These led to consistent results

(data not shown). Moreover, the observation of the effects of established cardiovascular Arachidonate 15-lipoxygenase risk factors, e.g., smoking, obesity, and previous hospitalisation with MI, on subsequent cardiac events [16] supports the validity of our study. Also, even though there were many risk and confounding factors included in the multivariate analysis, there was little difference between the adjusted and unadjusted results for the treatment effect. There are a number of limitations to our study. Several possible confounders are not recorded in the CPRD such as severity of osteoporosis, bone mineral density, menopause, physical activity, and family history of ischaemic cardiac events. However, the nested case–control design handles the heterogeneity of the population (by matching cases with controls using the most important potential confounders and adjusting the analyses on the remaining risk and confounding factors). There is a potential for channelling bias due to confounding by severity of osteoporosis or possible links between osteoporosis and cardiovascular disease [17].