Brittle Bones and Broken Hips: Drugs Aren't the Answer
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Thursday, June 25, 2015 10:59 AM

Quick Brief: The British Medical Journal reports that after reviewing 33 previous studies, the conclusion is that medications for osteoporosis do little to prevent hip fractures, and that focus on drug treatment has eclipsed other approaches patients can take to prevent fractures, such as nutrition and exercise. "Advice that works for anyone, regardless of bone fragility, and the benefits encompass the entire human body," the paper says. 

As for drug treatment, the researchers conclude, "the dominant approach to hip fracture prevention is neither viable as a public health strategy nor cost effective."

 

Drugs to increase bone strength that have reaped billions of dollars in sales aren't worth the cost and the risk of side effects, researchers argue in the British Medical Journal

Medications for osteoporosis do little to prevent hip fractures, the most devastating consequence of the disease, the authors conclude. And they can sidetrack patients who should instead be exercising, eating right, and quitting smoking.

The BMJ analysis of data from 33 previous studies suggests that few people benefit from drugs intended to prevent broken hips. Drug therapy "can achieve at best a marginal reduction in hip fractures at the cost of ... serious medical adverse events, and forgone opportunities to have greater impacts on the health of older people" through lifestyle changes, the authors write.

To prevent a single hip fracture a woman with osteoporosis would need to take medicine for three years to have a 1-in-175 chance that it would help them avoid a broken hip.  Medication to prevent fractures "hasn’t really been proven to make a difference in the population" as a whole, one author said.

The BMJ paper goes further, describing a classic campaign of disease-mongering, or aggressively expanding the population eligible for treatment. Before the 1980s, osteoporosis was diagnosed only after a fracture. But drug companies supported the development of diagnostic guidelines and tools to assess the risk of osteoporosis and identify candidates for treatment, the article says. They heavily promoted new technology to measure bone density. Now about three-quarters of white women over 65 are considered candidates for treatment under U.S. guidelines, according to the BMJ analysis. 

Three leading bone drugs have generated more than $17 billion in combined revenue since 2007 for Merck, Actavis, and Roche, according to data.

The study doesn't dispute that the drugs can be effective in strengthening bones. What's not clear is whether the current approach of widespread screening for osteoporosis and medication for those with fragile bones works.  The problem is that fractures are typically caused by falls, both in people with osteoporosis and in those with normal bone density. Lots of people who don't have osteoporosis fall and break bones anyway. Lots of people who do have osteoporosis don't fall and never sustain fractures. Predicting who's at risk is difficult, so drugs known as bisphosphonates that strengthen bones are prescribed for many people who will not fall, as well as some who will. Furthermore, though the risk of falling increases as people age, there's little evidence to show that the drugs help prevent hip fractures among the oldest patients who are most susceptible.

Doctors are ignoring evidence of overtreatment. "Most of the doctors are concerned about undertreatment. They are fine with treating hundreds of people unnecessarily if they can help the one that’s going to be harmed,” another author said.  Every medical intervention carries the chance of harm as well as benefit. Osteoporosis drugs can have serious consequences, including osteonecrosis of the jaw—the death of jaw bone cells—and increased risk of another type of fracture, called atypical femoral fractures.  A review by the Food and Drug Administration in 2012 raised concerns about the long-term use of the drugs.

Focus on drug treatment has eclipsed other approaches patients can take to prevent fractures, such as nutrition and exercise. "This advice works for anyone, regardless of bone fragility, and the benefits encompass the entire human body," the paper says. As for drug treatment, the researchers conclude, "the dominant approach to hip fracture prevention is neither viable as a public health strategy nor cost effective."


Source:  http://www.bloomberg.com/news/articles/2015-05-28/brittle-bones-and-broken-hips-drugs-aren-t-the-answer-study-finds