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BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c4464 (Published 18 August 2010) Cite this as: BMJ 2010;341:c4464

Bisphosphonates don’t seem to increase risk of oesophageal or stomach cancer

Treatment with oral bisphosphonates can cause inflammation of the oesophagus but it is unclear whether it also increases the risk of oesophageal cancer and stomach cancer. No evidence for such a link was found in the UK’s general practice research database. The study lasted 4.5 years, the mean age of participants was 70 years, and 81% were women.

The incidence of cancer in more than 40 000 people taking bisphosphonates was compared with that in controls who were matched for sex, age, and general practice. In both groups, 0.7 cancers occurred per 1000 person years of risk: 116 cancers (79 oesophageal) and 115 (72 oesophageal) in the bisphosphonate group and control groups, respectively. Hazard ratios—controlled for smoking, alcohol intake, and body mass index, as well as for use of hormone therapy, non-steroidal anti-inflammatory drugs, H2 antihistamines, and proton pump inhibitors—were 0.96 (95% CI 0.74 to 1.25) for both cancers combined and 1.07 (0.77 to 1.49) for oesophageal cancer only.

No excess risk was seen for any subtype of bisphosphonate, duration of use, or previous history of gastro-oesophageal reflux disease. Bisphosphonates are commonly prescribed for the prevention or treatment of osteoporosis. In 2005 in the UK, about 10% of women over 70 years were prescribed these drugs.

No need to start dialysis too early in severe kidney disease

When should dialysis be started in people with severe and progressive chronic kidney disease? A trial of 828 men and women with stage V chronic kidney disease, carried out in 32 centres across Australia and New Zealand, compared starting dialysis early (when the estimated glomerular filtration rate was 10-14 ml/min/1.73 m2 of body surface area) or late (5-7 ml/min/1.73 m2). Median time to the start of dialysis was 1.8 months in the early start group compared with 7.4 months in the late start group. Because of clinical symptoms, …

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