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: https://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.

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This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



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