The benefits of bisphosphonates for the prevention of fracture in patients with osteoporosis are not disputed,1 2 and one trial has also reported reduced mortality in these patients.3 Nevertheless, bisphosphonates are underused by those most likely to benefit—elderly patients with fractures.2 This shortfall in care was difficult to rectify even while bisphosphonates were considered effective and safe,2 but matters will probably get worse after recent reports that these drugs might increase the risk of atrial fibrillation.3 4 5 6 Even fewer eligible patients are now likely to start taking bisphosphonates, and more treated patients are likely to stop taking them. This would be justified if the risk of atrial fibrillation were real and large enough to offset the known benefits for fracture reduction. However, this potentially increased risk is challenged by an accompanying population based observational study by Sørensen and colleagues, which finds no significant increase in atrial fibrillation or flutter in women taking bisphosphonates for osteoporosis.7

It was only a matter of time before osteoporosis, its treatments, and cardiovascular events were linked.8 9 Osteoporosis is common, it …