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Senior Citizen Health & Medicine
Study Fails to Find Best Osteoporosis Medicine for
Preventing Fractures
About half of women 50 and older will suffer an
osteoporosis-related bone break
 Dec. 19, 2007 - Many medications reduce the risk of
bone fractures in people with osteoporosis, but the most commonly used
drugs - bisphosphonates - have not been proven more effective than
alternatives, according to a new report.
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Osteoporosis, affects about 44 million Americans,
especially post-menopausal women. It occurs when deteriorating tissue
reduces bone density in the spine, hip and other areas and often leads
to disability and chronic pain.
The report, funded by the Agency for Healthcare
Research and Quality (AHRQ), compared the effectiveness and risks of six
bisphosphonates: alendronate (sold as Fosamax), etidronate (Didronel),
ibandronate (Boniva), pamidronate (Aredia), risedronate (Actonel) and
zoledronic acid (Zometa).
The report also looked at estrogen, calcitonin (a
man-made hormone), calcium, vitamin D, testosterone, parathyroid hormone
and selective estrogen receptor modulators (SERMs).
Not enough scientific evidence exists to establish
whether bisphosphonates are better at preventing fractures than
estrogen, calcitonin or raloxifene, according to the report.
Some agents, however, such as estrogen and
raloxifene (a SERM), can have serious side effects such as strokes,
blood clots in the lungs or bleeding in the uterus.
The effectiveness of calcium and vitamin D,
meanwhile, may vary according to dosing, how often they are taken and
whether the patient taking them is at high risk for a fracture. There
is limited evidence to compare the supplements with other therapies for
preventing fractures.
The report also found that many osteoporosis
patients stop taking their medications as prescribed. Some stop because
they experience no osteoporosis symptoms. Others stop because of
medication side effects or because dosing is too frequent.
This finding was also true for supplements such as
calcium.
Not taking medications as prescribed increases the
chances of bone fractures. Patients who take bisphosphonates in weekly
formulations, rather than daily, are more likely to follow
prescriptions. An article based on the report was posted online in the
Annals of Internal Medicine.
As more Americans live longer, osteoporosis will
have a greater impact on health and quality of life, said AHRQ
Director Carolyn M. Clancy, MD. This report will help health care
providers and patients understand what we really know and dont know
about the array of available treatments.
Some people with the disease fracture bones, become
disabled or experience chronic pain. Overall, about half of women age 50
and older will suffer an osteoporosis-related bone break in their
lifetime. About one-fourth of those who fracture a hip will die within a
year.
Bisphosphonates, the most commonly used medications
for osteoporosis, are non-hormonal drugs that bind to bone to protect
against tissue breakdown. AHRQs analysis found that five
bisphosphonates alendronate, etidronate, ibandronate, risedronate and
zoledronic acid plus calcitonin, parathyroid hormone, estrogen and
raloxifene prevent spinal fractures.
Evidence also showed that alendronate, risedronate
and zoledronic acid, as well as estrogen and parathyroid hormone,
prevent hip and other non-spinal fractures.
Direct comparisons, however, have not shown
bisphosphonates to be superior to other therapies in preventing bone
fractures. No single bisphosphonate has been proven most effective in
that class.
The AHRQ report, Comparative Effectiveness of
Treatments To Prevent Fractures in Men and Women With Low Bone Density
or Osteoporosis, summarized the scientific evidence in 101 published
articles. It was authored by the Southern California Evidence-based
Practice Center at the RAND Corporation in Santa Monica, CA.
Among the conclusions:
● Among post-menopausal women with osteoporosis,
alendronate, etidronate, ibandronate, risedronate, calcitonin,
teriparatide (a form of PTH) and raloxifene reduce fracture risks.
● Not enough evidence exists to determine how
exercise or taking testosterone compares to medications in preventing
osteoporosis-related fractures.
● Calcitonin, risedronate and teriparatide
reduce fracture risks among men.
● For people at increased risk of falling, such
as those with partial paralysis or Parkinsons disease, fracture risks
are reduced if they are treated with alendronate, risedronate or vitamin
D.
● Risks associated with many osteoporosis
treatments are generally moderate or small. Although ulcers in the
esophagus were reported in trials of all the bisphosphonates except
zoledronic acid, these also occurred in patients not taking these drugs.
● Patients who take raloxifene face increased
risk of blood clots in the lungs and other areas as well as mild cardiac
problems such as chest pains or palpitations. One study found tamoxifen
(a SERM) increased the risk of lung blood clots.
● In rare cases, dramatic jaw bone deterioration
can occur in cancer patients taking intravenous bisphosphonates in large
doses.
The report on osteoporosis medications is the
newest analysis from AHRQ's Effective Health Care program. That program
represents an important federal effort to compare alternative treatments
for significant health conditions and make the findings public. The
program is intended to help patients, doctors, nurses and others choose
the most effective treatments. Information on the program, including
full reports, can be found at
http://www.effectivehealthcare.ahrq.gov.
The Agency for Healthcare Research and Quality
(AHRQ) is part of the U.S. Department of Health and Human Services.
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