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Risk of glaucoma with bisphosphonate use in patients with osteoporosis: a case-control study

Eye volume 39, pages 1160–1164 (2025)Cite this article

Subjects

Abstract

Purpose

Bisphosphonates (BPs) are first line agents commonly used in the management of osteoporosis. There have been two case reports that have suggested a possible link between BPs and acute angle closure (AAC). In the absence of any large epidemiologic studies, we sought to determine the risk of AAC and OAG with bisphosphonate use in patients with osteoporosis.

Methods

This was a retrospective cohort study with a case control analysis from 2008–2018. The study used the PharMetrics Plus Database (IQVIA, USA) which captures health claims for over 150 million unique patients, with fully adjudicated pharmacy and medical claims, and represents all geographic areas of the United States. 208,111 patients with osteoporosis were included in the study. AAC and OAG cases were defined by an ICD-9/10 code and had to have at least one prescription for bisphosphonate every 3 months in the year prior to the index date. The date of the first event of AAC was designated as the index date.

Results

Bisphosphonate users were more likely to develop AAC than non-users (adjusted IRR = 1.78, 95%CI [1.05–3.01]). In particular, those on risedronate were more likely to develop AAC compared to patients who used other formulations of bisphosphonates (adjusted IRRs = 2.12, 95%CI [1.05–3.01]). There was no risk for OAG with bisphosphonate use.

Conclusions

Patients with osteoporosis who used BPs were at a higher risk for AAC compared to those who did not, and those who were on risedronate were more likely to develop AAC compared to patients who used other types of bisphosphonates.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This study was funded by the Glaucoma Research Society of Canada Project Grant.

Author information

Authors and Affiliations

  1. Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada

    Bonnie He, Rami Darwich & Brennan Eadie

  2. Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada

    Mahyar Etminan

  3. Collaboration for Epidemiology of Ocular Diseases, Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Mahyar Etminan

Authors
  1. Bonnie He
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  2. Mahyar Etminan
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  3. Rami Darwich
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  4. Brennan Eadie
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Contributions

Conceptualization: BH, RD, ME, BE. Data curation: BH, ME. Formal analysis: ME. Funding acquisition: BH, RD, ME, BE. Investigation: BH, ME, BE. Methodology: BH, RD, ME, BE. Project administration: BH, ME, BE. Resources: BH, RD, ME, BE. Software: ME. Supervision: ME, BE. Validation: BH, ME, BE. Visualization: BH, ME, BE. Roles/Writing—original draft: BH. Writing—review & editing: BH, ME, BE.

Corresponding author

Correspondence to Bonnie He.

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He, B., Etminan, M., Darwich, R. et al. Risk of glaucoma with bisphosphonate use in patients with osteoporosis: a case-control study. Eye 39, 1160–1164 (2025). https://doi.org/10.1038/s41433-024-03574-4

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