to the editor: The clinical effectiveness of bisphosphonates are often overly touted. A Cochrane review on the effectiveness of alendronate (Fosamax) showed that for secondary prevention a dose of 10 mg a day resulted in clinically important and statistically significant reductions in vertebral (number needed to treat [NNT] = 16), nonvertebral (NNT = 50), hip (NNT = 100) and wrist fractures (NNT = 50).¹ The secondary prevention population was defined as having a bone density of at least 2 standard deviations below peak bone mass and/or one or more vertebral compression fractures. However, for primary prevention there were no significant reductions in fractures other than vertebral fracture (NNT = 50).

It is also important to put risk or harm in perspective. A 2007 review of the literature reporting osteonecrosis of the jaw in patients treated with oral bisphosphonates² yielded only 11 publications and 26 cases of osteonecrosis. Given the millions of patients treated with bisphosphonates, this would seem to make the risk of osteonecrosis of the jaw exceedingly small.