New Therapeutics Letter - Bisphosphonates: Do they prevent or cause bone fractures?

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THERAPEUTICS LETTER ISSUE 78 / MAY - AUG 2010

Previous Therapeutics Letters have highlighted important high quality systematic reviews by other independent groups such as Prescrire (France) and the Cochrane Collaboration. This Letter presents the abstract and highlights of a review produced by an independent Spanish organization and published in the Drug and Therapeutics Bulletin of Navarre (BIT, vol. 17, nr. 5, Nov-Dec 2009).  We encourage readers to read and comment on the full 23 page article in English or Spanish.

 

 

Abstract

 
Objective: to describe the effects of bisphosphonates with respect to whether they prevent or cause bone fractures.
Methods: a review of the main short and long-term randomized clinical trials, long-term cohort studies and case reports of atypical fractures with bisphosphonates published in MEDLINE since 1965.
Results: the effect of treatment with bisphosphonates versus placebo for short and long-term studies is described in absolute terms for the incidence of vertebral, hip and “non-vertebral” fractures. In addition, the current evidence on atypical femur fractures associated with bisphosphonate use is summarized.
Conclusions: 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.