Letters to the Editor
Are Bisphosphonates Effective in Preventing Fractures?
Am Fam Physician. 2010 Apr 1;81(7):840.
Original Article: Diagnosis and Treatment of Osteoporosis
Issue Date: February 1, 2009
Available at: http://www.aafp.org/afp/2009/0201/p193.html
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.
Author disclosure: Nothing to disclose.
1. Wells GA, Cranney A, Peterson J, et al. Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev. 2008;23(1):CD001155.
2. Pazianas M, Miller P, Blumentals WA, Bernal M, Kothawala P. A review of the literature on osteonecrosis of the jaw in patients with osteoporosis treated with oral bisphosphonates: prevalence, risk factors, and clinical characteristics. Clin Ther. 2007;29(8):1548–1558.
Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: firstname.lastname@example.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 2010 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions