A debate surrounding osteoporosis screening and bisphosphonate use has been roiling both physicians and patients. The controversy has been brewing for some time, but a recent article in the New York Times may have added fuel to the fire.
In it, Jane Brody wrote that a “perfect storm” is threatening to erase decades of progress in bone health for Americans.1 She highlighted her point by quoting a study of Medicare claims data that showed hip fracture rates for postmenopausal women had decreased each year between 2002 and 2012. But after that, fracture rates curiously levelled off. Had the decline continued, 11,000 additional hip fractures could have been avoided between 2013 and 2015.2
In 2010 the US FDA added a warning to the drug label of bisphosphonates about the risk of atypical fractures, specifically femur fractures and osteonecrosis of the jaw, and added that these fractures may be the result of long-term use. Even though the FDA also stated that these fractures are “very uncommon,” occurring in fewer than 1% of all people who experience hip and femur fractures, the issue may have been enough to make many patients jittery about taking these drugs.3 Some physicians who have seen a patient experience one of these devastating fractures may also think twice before prescribing bisphosphonates aggressively.
A likely result is that use of Fosamax decreased by 50% between 2008 and 2012, about the time of media reports about these safety concerns, according to one study.4
But is a “perfect storm” really brewing? Are patients putting their bones at risk by not taking bisphosphonates?
1. Brody J. A perfect storm for broken bones. New York Times. February 12, 2018. Accessed March 20, 2018.
2. Lewiecki EM, Wright NC, Curtis JR, et al. Hip fracture trends in the United States, 2002 to 2015. Osteoporos Int. 2018;29:717-722. doi: 10.1007/s00198-017-4345-0.
3. FDA Drug Safety Communication. Safety update for osteoporosis drugs, bisphosphonates, and atypical fractures 10/13/2010. Accessed March 20, 2018.
4. Jha S, Wang Z, Laucis N, Bhattacharyya T. Trends in media reports, oral bisphosphonate prescriptions, and hip fractures 1996-2012: an ecological analysis. J Bone Miner Res. 2015;30:2179-2187.
5. Cassel A. Perfect storm for broken bones or for disease-mongering of osteoporosis? HealthNewsReview.org. Accessed March 20, 2018.
6. Spiegel A. How a bone disease grew to fit the prescription. NPR. December 21, 2009
7. Järvinen TL, Michaëlsson K, Aspenberg P, et al. Osteoporosis: the emperor has no clothes. J Intern Med. 2015;277:662-673. doi: 10.1111/joim.12366.