Osteoporosis and the Evidence for Bisphosphonates

A recent review of all the significant short- and long-term randomized controlled trials and cohort studies since 1965 with respect to the use of bisphosphonate medication in the treatment of osteoporosis has revealed some very interesting insights.

In the short-term, bisphosphonates show some effectiveness in preventing vertebral fractures demonstrated by x-ray. The efficacy with regard to preventing hip fractures is uncertain; for primary prevention, hip fractures are not reduced, and for secondary prevention, the effect is of small magnitude and of questionable clinical relevance. In the long-term, there is an increased risk of atypical fractures affecting the subtrochanter and diaphysis of the femur. In addition, one cohort study suggests the incidence of hip fractures could be increased instead of reduced. Clarification of the long-term effects of bisphosphonates is therefore necessary and suspension of the use of these drugs for osteoporosis should be considered.

Given these results, it would seem very prudent to re-evaluate whether treating osteoporosis with bisphosphonates such as Didronel, Actonel and Fosamax is providing the individual with any clinical (read: personal) benefit. That said, I’m not suggesting substantial osteoporosis be left unchecked and un-treated. Quite the contrary, we just need to be sure that the treatments provided are effective, safe and evidence-based.