Osteoporosis drugs may not be best choice

The reputation of bisphosphonates, the most widely prescribed osteoporosis drugs on the market, has taken a beating lately.

Last month, a study in the New England Journal of Medicine by the U.S. Food and Drug Administration found inconsistencies in the ability of bisphosphonates to reduce fractures and suggested the drugs may not have much benefit for many women. In an accompanying article, researchers questioned whether women who are at a high risk for fractures and are currently taking the drugs would be better off only using them for a short period.

The same month, a study in the Archives of Internal Medicine found women taking bisphosphonates appear to actually face a higher risk of suffering rare, but very serious, atypical femoral fractures which account for less than 1 per cent of all hip and femur fractures. Unlike most fractures, atypical femoral fractures arent usually the result of a fall or other trauma; the thigh bone appears to snap for no reason. Healing can take months or years and the fractures may lead to complications.

Last December, Health Canada announced it was updating the warning label on bisphosphonate drugs in light of evidence they are linked to a higher risk of rare atypical femoral fractures. Plenty of credible research has also suggests the drugs may lead to osteonecrosis of the jaw, a rare and painful deterioration of the jaw bone, and even esophageal cancer.

These are just the latest blows to a class of drugs that, for years, was prescribed to millions of women with osteoporosis or believed to be at risk of developing the disease.

In light of the evidence, a growing segment of the medical community says its time to revamp the way bisphosphonates are prescribed in order to restrict use in women who clearly wont benefit from them. At the same time, many osteoporosis doctors seem reluctant to admit theres a big problem, which is leading to widespread confusion.

I think its a huge problem for patients, said Clifford Rosen, professor of medicine at Tufts University, senior scientist at Maine Medical Centers Research Institute and one of the authors of the NEJM article that was published last month.

Bisphosphonates are a class of drugs, such as Fosamax and Aclasta, that are thought to prevent bone loss by binding to the surface of bones. Depending on the type, they can be taken daily, monthly or even yearly and some research indicates they continue to provide protective effects long after patients stop taking them.

The main points of contention over the drugs are who should be taking them, and for how long. When the drugs first came on the market in the mid-1990s, they were believed to help prevent osteoporosis and halt its progression, which meant many women, including those without the disease, were put on them, Dr. Rosen said.

Within a few years, reports began emerging of rare but serious side effects and more research was done to assess these drugs.

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Osteoporosis drugs may not be best choice