Pre-osteoporosis treatment benefit is exaggerated
Potential benefits of drugs for treating pre-osteoporosis have been exaggerated and the side effects understated in recent post-hoc analyses, the authors of a BMJ article argue (2007;336:126).
Pharmaceutical companies in Europe have already started to market drugs to women with pre-osteoporosis, say the authors, a move that they believe raises serious questions about the benefit-risk ratio for low-risk individuals.
Pablo Alonso-Coello, a family practitioner in Barcelona, and colleagues explain that, in recent years, several research groups have reanalysed data from original trials of osteoporosis drugs, including alendronate, raloxifene, risedronate and strontium ranelate. The aim was to identify subgroups of patients who would benefit from treatment for pre-osteoporosis, believed to affect half of all older women.
The authors argue that the reanalyses focus more heavily on the relative reduction in fracture risk than the absolute reduction, which is low for those without major risk factors. They also say that the reanalyses play down the known side effects of the drugs. In addition, all of the original trials were funded by pharmaceutical companies and in three out of four of the reanalyses, drug company employees were part of the team examining the data, say the authors.
“Notwithstanding the genuine value of these drugs in reducing risk fracture for some women, we need to ask whether the coming wave of marketing targeting these women with pre-osteoporosis will result in the sound effective prevention of fractures or the unnecessary and wasteful treatment of millions of healthy women,” they conclude.
Fracture risk
A change of focus in fracture prevention from osteoporosis to falls is needed, a separate BMJ paper suggests (2007,336:124). The authors argue that falling, not osteoporosis, is the strongest single risk factor for fractures in elderly people. They say that bone mineral density is a poor predictor of fracture risk and that drug treatment is expensive and will not prevent most fractures in elderly people. They add that some trials show falls in elderly people can be reduced by up to 50 per cent through various strategies. Evidence is most consistent for strength and balance training, ensuring sufficient intake of calcium and vitamin D, and reducing the number and doses of psychotropic drugs. |
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