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October 21, 2015
Bisphosphonates Highly Effective in Reducing Additional Fragility Fractures
Chicago—How effective is antiosteoporotic therapy in decreasing the risk of additional bone breaks in patients with a history of fragility fracture? That is the question answered in a study published recently in The Journal of Bone & Joint Surgery. Researchers from the University of Chicago and colleagues report that therapy to increase bone mineral density and slow or stop the loss of bone tissue can substantially decrease the risk of subsequent fractures. “Fragility fractures have a major impact on patients' pain, function, and quality of life. They also account for a tremendous healthcare cost,” lead author Harpreet S. Bawa, MD, said in an American Academy of Orthopaedic Surgeons press release. “This study shows that initiation of anti-osteoporotic therapy following a fragility fracture can reduce subsequent fracture risk by 40% over three years and can prevent a subsequent fracture in one out of every 27 patients treated.” For the 3-year study, researchers used the The Truven Health MarketScan databases to look at 31,069 patients 50 or older who had sustained a fragility fracture, defined as any fracture of the wrist, proximal part of the humerus, hip, or vertebra, and had three years of continuous enrollment following fracture. Participants were divided in a nontreatment and a treatment group, which represented 10.6% of the overall group and where patients received bisphosphonates such as raloxifene, teriparatide, denosumab, and calcitonin. The intervention group also was determined to have had “adequate” treatment, defined as using anti-osteoporotic therapy for at least 80% of the time between the initial prescription and completion of the last prescription. Overall, the treatment group showed a 34% reduction in hip fractures, a 43% reduction in spine fractures, and a 52% reduction in upper arm fractures. An accompanying commentary notes that, despite the effectiveness of bisphosphonates, their use has declined and controversy continues about their side effects. “According to the Task Force of the American Society for Bone and Mineral Research, the relative risk of atypical femoral fractures is very high in patients using bisphosphonates, but their absolute risk is extremely low,” writes Kevin L. Ong, PhD, of Exponent in Philadelphia. “These fractures are also noted to be rare, particularly when considered against the incidence of all types of fragility fractures and ordinary femoral neck or intertrochanteric fractures, which decrease with bisphosphonate therapy. Furthermore, a causal relationship between bisphosphonates and atypical femoral fractures has not been established and bisphosphonates continue to be considered an appropriate treatment option for osteoporosis.” Ong points out that the study “provides additional evidence of the benefits of adequate anti-osteoporotic therapy in decreasing the risk of subsequent fractures across multiple fracture sites and the benefits of multiple anti-osteoporotic therapy treatments.”
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