Patients Avoiding Newer Osteoporosis Drugs Because of Rare Risks — Physician’s First Watch

Medical News |
June 3, 2016

Patients Avoiding Newer Osteoporosis Drugs Because of Rare Risks

By Kelly Young

Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS

Patients with osteoporosis are avoiding use of bisphosphonates because of the rare risk for atypical fracture, the New York Times reports.

In May, the American Society for Bone and Mineral Research, the National Osteoporosis Foundation and the National Bone Health Alliance highlighted the dangers of not treating osteoporosis aggressively after a first fracture. A study found that 1 year following first major osteoporotic fracture, patients had triple the risk for a second fracture relative to the general study population.

After media reports of safety concerns, a 2015 study found that oral bisphosphonate use fell more than 50% from 2008 to 2012.

"You only need to treat 50 people to prevent a fracture, but you need to treat 40,000 to see an atypical fracture," Dr. Clifford J. Rosen told the Times.

Reader Comments (4)

DEBORAH WAUGH

I have been advised by my doctors to stop taking actonel even though I have osteoporosis of the hip and have had two compression back fractures.

Geraldine Moses Other Healthcare Professional, Pharmacology/Pharmacy, hospital

To what extent could this decline in bisphosphonate use be attributed to the introduction of denosumab ? Did they account for that?? Denosumab has been enthusiastically adopted both by specialists and in primary care to replace bisphosphonates. And the timing would fit.

Allison Stieber, MSJ Other

I'm writing from the standpoint of a patient who has been advised to take an osteoporosis drug but has refused.

The NY Times article fails to mention that the FDA has become sufficiently concerned about the "extremely rare" side effects that it now recommends doctors identify patients who are candidates for a "drug holiday." This reflects the increasing recognition that the "extremely rare" effects become more frequent after the drugs have been taken for a few years.

As for Dr. Rosen's statement that "You only need to treat 50 people to prevent a fracture," maybe I'm missing something as a mere layperson, but this doesn't sound like a compelling statistic in favor of the drugs to me -- especially considering the risk one runs of having an (arguably) "extremely rare" catastrophic side effect that often is untreatable (osteonecrosis of the jaw) or that requires a grueling, debilitating treatment regimen (atypical femoral fracture).

german cruz Physician, Obstetrics/Gynecology, HOSPITAL

VERY GOOD NEWS

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