Oral Bisphosphonates and Risk of Esophageal Cancer: A Dose-Intensity Analysis in a Nationwide Population

Abstract

Esophageal cancer has been associated with oral bisphosphonate use, but current data are conflicting and devoid of Asian studies where esophageal squamous carcinoma prevails. We assessed the association between dose intensity, stratified by use duration (observation period) and exposure frequency, of oral bisphosphonates and the risk of esophageal cancer using 16,204 esophageal cancer cases and 64,816 malignancy-free controls identified from the population-based National Health Insurance Research Database of Taiwan from 1997 to 2008. Neither duration nor frequency of bisphosphonate exposures was positively correlated to esophageal cancer risk. The ORs for rare users of 1-, 3-, 5-year observation periods were 3.86, 2.58, and 2.27, respectively (P < 0.001). Similar trend of descending ORs was also observed for rare-, frequent-, and regular users of 1-year observation period (ORs = 3.86, 1.93, and 0.95, respectively). Our data suggest that bisphosphonates are not likely risk factors for esophageal cancer in Taiwan. The study shows no evidence of an association between bisphosphonate use and esophageal cancer risk from Asian perspective.