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Hip Fracture Drug Prevention Strategies Are 'Pointless'
May 28, 2015 | Medical News Today
By Markus MacGill
... The mainstay of drug treatment aimed at preventing osteoporosis is a group of agents known as bisphosphonates sold under the following US brand names: Actonel, Actonel+Ca, Aredia, Boniva, Didronel, Fosamax, Fosamax+D, Reclast, Skelid and Zometa. The harms to patients of overdiagnosis and overtreatment, says the article, include adverse events associated with drug treatment... -
Drug Approach To Preventing Hip Fractures Lacks Evidence And Leads To Unnecessary Harm, Say Experts
May 27, 2015 | MinnPost
By Susan Perry
...Sales of Fosamax and other drugs for the treatment of osteoporosis — as well as sales of the devices for measuring bone density — skyrocketed. The amount spent on the drugs alone tripled between 2001 and 2008, and is expected to exceed more than $11 billion in 2015, according to background information in the BMJ paper...
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Hip Fracture Drug Prevention Strategies Are 'Pointless'
May 28, 2015 | Medical News Today
By Markus MacGill
Prof. Teppo Järvinen has written an opinion piece with colleagues in The BMJ to say that drug treatment "can achieve at best a marginal reduction in hip fractures at the cost of unnecessary harms and considerable waste of monetary resources."
The article is part of the journal's campaign to highlight "the threat to human health and the waste of resources caused by unnecessary care."
The authors cite a review of the evidence to show that 175 postmenopausal women with bone fragility must be treated for about 3 years to prevent one hip fracture.
The mainstay of drug treatment aimed at preventing osteoporosis is a group of agents known as bisphosphonates sold under the following US brand names: Actonel, Actonel+Ca, Aredia, Boniva, Didronel, Fosamax, Fosamax+D, Reclast, Skelid and Zometa.
The harms to patients of overdiagnosis and overtreatment, says the article, include adverse events associated with drug treatment, "such as gastrointestinal problems, atypical femoral fractures, and osteonecrosis of the jaw" in addition to the "imposed psychological burden" of a raised worry about fracture when the diagnosis of higher risk is made.
The authors choose a damning conclusion: "The dominant approach to hip fracture prevention is neither viable as a public health strategy nor cost-effective." They add:
"Pharmacotherapy can achieve at best a marginal reduction in hip fractures at the cost of unnecessary psychological harms, serious medical adverse events, and forgone opportunities to have greater impacts on the health of older people.
As such, it is an intellectual fallacy we will live to regret."
The US guidelines cited by the authors as leading to "overdiagnosis" are produced by the National Osteoporosis Foundation (NOF). While these do place importance on diagnosis and on doctors offering "counsel on the risk of osteoporosis and related fractures," along with pharmacotherapy recommendations, they do also place emphasis on lifestyle and other non-drug measures to reduce risk, including: Diet with adequate calcium intake (for men aged 50 to 70 years, 1,000 mg a day, and for women 51 years and older and men 71 and older, 1,200 mg a day) Adequate vitamin D intake, including via supplements if needed for men and women aged 50 years and older (800-1,000 IU a day) Regular weight-bearing and muscle-strengthening exercise to improve agility, strength, posture and balance Giving up smoking and avoiding excessive alcohol intake.
The national recommendations also urge doctors to assess risk factors for falls and instigate "appropriate modifications" where needed - home safety, balance training exercises, review of medications and visual correction are the examples given that may need attention...
For full story:
http://www.medicalnewstoday.com/articles/294469.php
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Drug Approach To Preventing Hip Fractures Lacks Evidence And Leads To Unnecessary Harm, Say Experts
May 27, 2015 | MinnPost
By Susan Perry
The current emphasis on using prescription drugs to prevent hip fractures in older adults lacks good scientific evidence and is harming more people than it’s helping, according to an article published Tuesday in the BMJ.
“Pharmacotherapy can achieve at best a marginal reduction in hip fractures at the cost of unnecessary psychological harms, serious medical adverse events, and forgone opportunities to have greater impacts on the health of older people,” write the article’s authors, an international group of 11 physicians and researchers. “As such, it is an intellectual fallacy we will live to regret.”
The article is the latest contribution to the BMJ’s “Too Much Medicine” campaign, which has the goal of educating both the public and the medical community on “the threat to human health posed by overdiagnosis and the waste of resources on unnecessary care.”
And, indeed, how the medical community came to adopt its current drug-based approach to the prevention of hip fractures over the past three decades — and how the public has come to accept it as scientific dogma — is an all-too-familiar tale of overdiagnosis, overtreatment and disease fear-mongering.A need for prevention
As the authors of the article point out, hip fractures are devastating injuries, often leading to severe disability or death. In the United States, more than 250,000 adults aged 65 and older are admitted to hospitals for hip fractures each year, and 95 percent of those injuries are the result of falls, according to the Centers for Disease Control and Prevention (CDC).
One in three American adults who lived independently before fracturing their hip are confined to a nursing home for at least a year after their injury, and one in five dies within a year.
Those statistics do sound scary, particularly since we know that bones become more fragile with age. But here’s the problem: As defined today by bone density tests or risk calculators, bone fragility — or osteoporosis — is not a good predictor of hip fractures.Broadening the definition
As the authors of the BMJ article point out, until the late 1980s, osteoporosis was diagnosed only after a bone fracture had occurred.
That situation changed when 1) new technology (dual energy absorptiometry) was developed to measure bone mineral density at the spine and hip, and 2) the World Health Organization (WHO) — with the support of the pharmaceutical industry — introduced a new definition of osteoporosis, which was based on low bone mineral density.
That new definition was issued in 1994. A year later, the first drug to prevent hip fractures, a bisphosphonate called alendronate (Fosamax), came on the market.
Sales of Fosamax and other drugs for the treatment of osteoporosis — as well as sales of the devices for measuring bone density — skyrocketed. The amount spent on the drugs alone tripled between 2001 and 2008, and is expected to exceed more than $11 billion in 2015, according to background information in the BMJ paper.
The development of fracture risk assessment tools, such as FRAX (which was created by WHO with heavy funding from the pharmaceutical industry), has helped to feed those sales trends. For, as a 2009 study pointed out, if all white women over the age of 65 in the United States were to undergo a fracture risk assessment based on those tools, at least 72 percent of them — and 93 percent of the women over the age of 75 — would become candidates to receive drug treatment to prevent fractures...
For full story:
https://www.minnpost.com/second-opinion/2015/05/drug-approach-preventing-hip-fractures-lacks-evidence-and-leads-unnecessary-h
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