Oral bisphosphonates and femur fractures in the news: What’s the truth?

[SusanTiso]

There have been some recent reports in the news media about this, and patients are asking about the safety of these meds and whether or not they should discontinue them. The link to the FDA safety update as of 3/10/10 is below.

At this point, the data that FDA has reviewed have not shown a clear connection between bisphosphonate use and a risk of atypical subtrochanteric femur fractures.

Good to know! Please go to the link for more information on this recent report.

It's always interesting to me that a piece of medical information can be picked up by the media and spun around, reported, and the reach and power it has. The implications for patients are significant, creating anxiety and mistrust. Sometimes patients discontinue meds without professional advice, with potentially grave consequences. It's important for NPs and PAs, as patient advocates, to stay updated on the latest information and to use reliable sources.

http://www.fda.gov/Drugs/DrugSafety/.../ucm203891.htm

[rjrudij]

It is a shame that health care news can be miscontrued or taken out of context. Patients get very upset and really don't know what to think and get worried unnecessarily. We need to educate and and put things into perspective for our patients. For example you could say to the patient you have osteoporosis and you are at far greater risk for a fractured hip with high morbidity and mortality (say 65% chance) verses the less than 1% chance of having a fractured femur. So sometimes putting things into % or numbers help them understand what may be going on. On the other hand they may just stop their medication without ever telling you. That makes it hard. As a clinician we should all be going over health histories and medications every visit and use that opportunity to educate and clear up any misconceptions they may have.

[Lawrence Herman]

It is truly unfortunate that the media tells only part of the story, or worse still, preys upon the fears of patients and their families. But what is truly a disservice is when health care providers read only what is in USA Today and never read the full article. I have already had a local orthopaedic surgeon start to take my patients off bisphosphonates as a result of these reports. I had a patient with significant osteoporosis and compressions fractures that he pulled off a bisphosphonate indicating that this entire class of drugs was "proven unsafe." Now nothing I say will change this patients mind.

[eejjrr]

Study here from New England Journal of Medicine:

http://content.nejm.org/cgi/content/full/NEJMoa1001086

Biophosphonates do prevent remodeling so changes in stress patterns to long bones over a long period of time could lead to "atypical" fractures. Study does prove that this happens but is very rare and "statistically insignificant" compared to the typical fractures it prevents.