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Preventive Therapies for Fractures, Osteoporosis Analyzed

One analysis calls for fracture prevention efforts to focus on risk of falls, while a second questions osteopenia treatment

FRIDAY, Jan. 18 (HealthDay News) -- Controversies in osteoporosis management are addressed in two articles published in the Jan. 19 issue of BMJ. One article posits that efforts to reduce fractures in the elderly should focus on the prevention of falls, not the pharmacologic treatment of osteoporosis, while a second claims that proponents of pharmacologic treatment of "pre-osteoporosis" exaggerate the benefits of osteoporosis drugs while underplaying their harms.

Teppo Jarvinen, M.D., Ph.D., of Tampere University Hospital in Tampere, Finland, and colleagues argue that efforts to prevent hip fractures in the elderly should target falls, which are the strongest single risk factor for fractures. Other approaches, such as using pharmacologic agents to treat osteoporosis, are less desirable due to the high cost, suboptimal patient adherence, and only moderate efficacy of osteoporosis drugs in preventing hip fractures.

In the second article, Pablo Alonso-Coello, M.D., of Universidad Autonoma de Barcelona in Spain, and colleagues discuss the controversy surrounding drug treatment of osteopenia, reviewing four post-hoc analyses of osteoporosis trials. The researchers claim that these analyses exaggerate the benefits and minimize harms associated with osteoporosis drugs, such as focusing on the relative risk reduction of fractures rather than the more modest absolute risk reduction, and failing to mention serious side effects associated with these drugs.

Alonso-Coello and colleagues voice a word of caution regarding drug treatment of osteopenia: "Notwithstanding the genuine value of these drugs in reducing fracture risk for some women, we need to ask whether the coming wave of marketing targeting those women with pre-osteoporosis will result in the sound effective prevention of fractures or the unnecessary and wasteful treatment of millions more healthy women."

Abstract - Jarvinen
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Abstract - Alonso-Coello
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