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Experts Compare Osteoporosis Drugs

It's unclear that bisphosphonates such as Fosamax, Boniva are more effective than alternatives

TUESDAY, Dec. 18, 2007 (HealthDay News) -- There's no proof that widely used bisphosphonate drugs are more effective than other treatments at preventing fractures in people with osteoporosis, says a U.S. Agency for Healthcare Research and Quality (AHRQ) report published online Monday in the journal Annals of Internal Medicine.

The report authors analyzed 101 published studies in order to compare the effectiveness and risks of six bisphosphonates -- alendronate (Fosamax), etidronate (Didronel), ibandronate (Boniva), pamidronate (Aredia), risedronate (Actonel) and zoledronic acid (Zometa) -- along with estrogen, calcitonin (a man-made hormone), calcium, vitamin D, testosterone, parathyroid hormone and selective estrogen receptor modulators (SERMs).

The report concluded that there's not enough scientific evidence to determine whether bisphosphonates are better at preventing fractures than estrogen, calcitonin or raloxifene (a SERM). It also noted that some treatments, such as estrogen and raloxifene, can cause serious side effects such as strokes, blood clots in the lungs, or bleeding in the uterus.

The effectiveness of calcium and vitamin D in preventing fractures may vary according to dosing, how often they're taken, and whether a patient is at high risk for a fracture, the report said.

The report also found that many osteoporosis patients stop taking medications or supplements such as calcium, because they don't have any osteoporosis symptoms, they suffer side effects, or the dosing is too frequent. Not taking medications as prescribed increases the risk of fractures. People who take bisphosphonates in weekly formulations are more likely to stick to their medication regimen than those who take daily formulations.

"As more Americans live longer, osteoporosis will have a greater impact on health and quality of life. This report will help health care providers and patients understand what we really know -- and don't know -- about the array of available treatments," AHRQ Director Dr. Carolyn M. Clancy said in a prepared statement.

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more about osteoporosis.

SOURCE: U.S. Agency for Healthcare Research and Quality, news release, Dec. 17, 2007
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