Well it's back from summer vacation and reviewing what happened while I was away and today there was an article in the New York Times about the potential for increased risk of fracture with bisphosphonate drugs like Fosamax (alendronate) used for the treatment of osteoporosis. I previously wrote about this issue, and now there are continuing reports of abnormal fractures with Fosamax. For instance, Dean Loricher MD and colleagues reported a series of 25 patients on Fosamax who developed a fracture in the femur (thigh bone) that had a unique pattern only seen in Fosamax users (with one exception). In 2006 Jennifer Schneider MD made the unusual step of publishing a case report about herself having a bone fracture while riding along on the subway train while on Fosamax. Ouch!
Well a kudos to the paper for bringing up the issue and pointing out the risk of these drugs that are supposed to save you from fractures but as I have previously written about the topic in my book as well as in several blog posts this isn't exactly news. Also the coverage of the topic was frankly bizarre. First, a spokesperson for Merck, the manufacturer of Fosamax, stated that the drug may cause fractures in up to 5% of people but that "it reduced the risk of osteoporotic fracture in 95% of people." What exactly does this mean? That 95% of the people will be saved from a fracture? This is what the statement seems to imply and I think many people would interpret the statement that way. In fact, less than 5% of people will have an osteoporotic fracture over five years. This is really just a pharma marketing smoke screen.
The article quoted Susan Ott MD of the University of Washington who was one of the first to point out in the literature the possibility that Fosamax may in the longer run (after five years) make your bones more brittle, not less, as I quoted her in my book. However in this article she stated that if your 10 year risk of fracture is less than 3% you shouldn't take these drugs. Well I went to the handy dandy website site where there is a calculator to determine your ten year risk of osteoporosis. I pretended that I was a 60 year old woman of average height and weight with no risk factors for osteoporotic fracture, such as smoking, alcohol abuse, family history, prior fracture, use of steroid medications etc. I found that if I barely met the criteria for osteopenia (t score of less than -1.0) my risk of "major osteoporotic" fracture was 10% and risk of hip fracture was 0.6%. Since Dr. Ott did not specify whether she was talking about only hip fractures we have to assume that she thinks that I should be on drug. Since over half of 60 year old women meet criteria for osteopenia that means that all of these women should be on Fosamax. I found that if I met criteria for osteoporosis (t score less than -2.5) my ten year risk of "major osteoporotic" fracture was 16% and of fracture of the hip was 3%. The fact is that in either case with no prior history of fracture the studies have not shown a significant reduction in hip fractures, which is the only type of fracture that could lead to lasting disability. And interpreting her statement as meaning any type of "major fracture" she is advocating that all women with osteopenia should be on these drugs, i.e. half the postmenopausal female population.